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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607682
Report Date: 04/05/2022
Date Signed: 04/05/2022 11:56:03 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2019 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20190906143154
FACILITY NAME:HAYWORTH TERRACEFACILITY NUMBER:
197607682
ADMINISTRATOR:HELEN PAKFACILITY TYPE:
740
ADDRESS:325 N. HAYWORTH AVENUETELEPHONE:
(323) 655-3101
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:111CENSUS: 54DATE:
04/05/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Julie Arriola TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility has vermin.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted another visit to issue the final results of the investigation. LPA met with Staff, Julie Arriola who allowed entry into the facility and assisted with today's visit.

Regarding the allegation that the facility has vermin, the investigation consisted of Interviews with Adminstator, Staff #1- Staff #3, review of facility pest control invoices, and tour of facility. The investigation revealed : Staff interviewed denied the allegation that the facility has vermin. Facility staff stated that they are serviced by a pest control company who comes once a month as a precaution, however they do not have a problem with bed bugs, cockroaches, or rats. LPA did not observe any vermin during facility tour. Staff stated that they did have a problem with bed bugs in the past, but it has been resolved. Staff stated that there is a rat problem in the city of Los Angeles, and in the vacant lot that is adjacent to the facility, there are numerous homeless indiividuals. Staff interviewed stated that there are rats in the vacant lot. Staff stated that this creates a problem for their facility and surrounding businesses due to the food, and waste that is created.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
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 28-AS-20190906143154
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: HAYWORTH TERRACE
FACILITY NUMBER: 197607682
VISIT DATE: 04/05/2022
NARRATIVE
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Staff stated that the facility is working with a pest control company, to ensure that the rats do not come into the facility. Review of pest control invoices indicates that the facility is being treated for bed bugs.

Based on document review and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Facility has been previously cited for bed bugs on Complaint # 11-AS-20220124115553 and won't be cited today.

An exit interview was conducted with Staff, Julie Arriola. A copy of the report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2