197608297-4-28-2023-28-AS-TVAO-CSLTYA-20230608150822

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608297
Report Date: 04/28/2023
Date Signed: 04/28/2023 01:16:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/20/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230420113910

FACILITY NAME:	BELLA VISTA		FACILITY NUMBER:	197608297
ADMINISTRATOR:	BAKER, IAN		FACILITY TYPE:	740
ADDRESS:	1760 N FAIR OAKS AVE		TELEPHONE:	(626) 794-4103
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	72	CENSUS: 34	DATE:	04/28/2023
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Ian Baker, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility failed to address the pest infestation.
Facility is not reporting scabies outbreak.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced and met with Ian Baker. The purpose for the visit was explained.

The investigation consisted of the following:
LPA obtained the staff and resident rosters, pest control service reports, and toured the facility. Random rooms were selected to inspect. Interviews were held with the Administrator, 4 Staff, 4 Residents, and a private caregiver.

The investigation revealed the following:
Allegation – Facility failed to address the pest infestation. According to the administrator, there has not been any reports of bed bugs or cockroaches at the facility. He acknowledged that there was an infestation of bed bugs a few years ago and after that case, the facility continued with pest control services for bed bugs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230420113910

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BELLA VISTA	FACILITY NUMBER: 197608297
	VISIT DATE: 04/28/2023

NARRATIVE

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He stated the pest control exterminator comes twice a week and sprays 5 rooms on each visit as a preventative measure for bed bugs. Another pest control company comes once a month to spray the facility for roaches and rodents. In addition, a bed bug heater was purchased to use in the event there is a report of bed bugs. LPA interviewed 4 other staff and they stated the bed bugs issue is under control. They have not observed any bed bugs nor roaches at the facility lately. They also stated that the exterminator checks and sprays for bed bugs twice a week. The staff clean and spray the rooms daily as well as changing the bedsheets often. LPA interviewed 4 residents and a private caregiver during the visit today and all stated they have not seen any bedbugs or cockroaches. During the tour, LPA selected 5 random rooms to inspect and did not observe any pests. Based on the pest control reports, interviews, and observation, staff are taking measures to prevent any infestation of pests at the facility.

Allegation - Facility is not reporting scabies outbreak. Per the administrator, he is not aware of any residents having scabies at this facility. He stated there was a case roughly 2 years ago and has not heard of any since. Staff interviewed also stated they have not received any reports from residents being itchy or having rashes. The Residents and private caregiver interviewed today stated they do not have scabies and do not have any rashes on them. Per the Pasadena Public Health department, there is no known scabies outbreak at the facility.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Administrator Baker. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC9099 (FAS) - (06/04)

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