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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191601645
Report Date: 07/28/2022
Date Signed: 07/28/2022 12:10:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2022 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20220722144505
FACILITY NAME:BIXBY KNOLLS TOWERFACILITY NUMBER:
191601645
ADMINISTRATOR:ROB GOERZENFACILITY TYPE:
740
ADDRESS:3747 ATLANTIC AVENUETELEPHONE:
(562) 426-6125
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:65CENSUS: 51DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:DIRECTOR MARY ESCOBEDOTIME COMPLETED:
12:04 PM
ALLEGATION(S):
1
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9
Staff is not addressing insects in the facility
INVESTIGATION FINDINGS:
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5
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13
Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Bixby Knolls Tower facility on 07/28/2022 at 09:00 AM and was greeted by Director (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to investigate the complaint and deliver the findings pertaining to the above-mentioned allegation.

On 07/28/2022 around 09:00 AM LPA Calderon initiated an investigation for the above-mentioned allegation and conducted a face-to-face interview with Administrator (S1). On 07/28/2022 LPA Calderon requested copies of the pest control reports for the facility. On 07/28/2022 LPA Calderon interviewed R1-R5 for complaint and interviewed S2-S3 for complaint. On 07/28/2022 LPA Calderon reviewed pest control reports for the facility. On 07/28/2022 LPA Calderon interviewed W1 for complaint.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20220722144505
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BIXBY KNOLLS TOWER
FACILITY NUMBER: 191601645
VISIT DATE: 07/28/2022
NARRATIVE
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Regarding Allegation #1: Staff is not addressing insects in the facility. On 07/28/2022 LPA Calderon interviewed W1 who stated that W1 had visited R1 who complained of flies in R1 food. W1 states that W1 and R1 went to the dinning room for lunch around 11:30 am and witness staff opening doors to allow air to come inside the dinning room area, W1 states that flies came from outside and landed on R1 food and another residents food. W1 states that W1 did not complain to staff or the director and is very happy with the service provided by the facility. On 07/28/2022 LPA Calderon interviewed S1-S3 who state that no resident or witness has complained and staff state that there are no issues with roaches or ants. Staff states that the facility is sprayed monthly and staff states that flies do come into the dinning room area, but there is no problem at this time. On 07/28/2022 LPA Calderon reviewed pest control invoices for past 3 months and the reports state that the pest control has sprayed for roaches and ants, but there have been no issues. Pest control reports no issues with flies and no complaint has been noted by staff to the pest control people. On 07/28/2022 LPA Calderon interviewed R1-R5 who state that staff does open the doors to the outside and flies come into the room. Resident state that some flies land on residents food from time to time but there is no major issue or concerns. On 07/28/2022 LPA Calderon and Director walked into the dinning room and watched staff open the doors to the patio area, LPA Calderon did not note a major fly issue for the area.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of “Staff is not addressing insects in the facility” is found to be UNSUBSTANTIATED.



An exit interview was conducted and copy of the Complaint Report was provided to the Director.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2