197608604-4-6-2021-28-AS-MVAO-C5SQYU-20210811123542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 04/05/2021
Date Signed: 04/06/2021 03:38:51 PM

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 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
03/24/2021 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210324140518

FACILITY NAME:	PROMISE ASSISTED LIVING, LLC.		FACILITY NUMBER:	197608604
ADMINISTRATOR:	GREGORY Z. RESTUM		FACILITY TYPE:	740
ADDRESS:	1231 SOUTH ALVARADO STREET		TELEPHONE:	(310) 205-2591
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY:	22	CENSUS: 19	DATE:	04/05/2021
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Roxana Aparicio, Staff		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility has an infestation of bed bugs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to investigate the above allegation. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Roxana Aparicio, facility staff.

During the initial visit on 3/30/21, LPA Chan conducted telephone interviews with the Assistant Administrator, 4 residents, 1 staff, and a video call which consisted of a tour of residents' rooms #1, #2, #3, #9-10, #11, and #12. LPA also requested a copy of the staff and resident roster, and Orkin Pest Control service reports from January through Present. On 4/5/21, LPA Chan conducted additional interviews with the Administrator, 2 residents, 1 staff, and toured rooms #17/18, and #21.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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-20210324140518

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PROMISE ASSISTED LIVING, LLC.	FACILITY NUMBER: 197608604
	VISIT DATE: 04/05/2021

NARRATIVE

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Regarding allegation - Facility has an infestation of bed bugs.

Based on interview with the Assistant Administrator, there were some bugs (possibly bed bugs) spotted several weeks ago coming from items that a resident brought in and left in the hallway. She stated that the issue was handled right away and has not seen any lately. The 2 other staff interviewed stated they have not observed any bed bugs nor heard any residents mention about them. Staff indicated that the facility and bedrooms are cleaned daily to prevent any pests. 5 out of the 6 residents stated they have not observed any bed bugs and that the staff cleans their room daily. LPA reviewed the Orkin Pest Control service reports provided and verified with a Orkin representative that there have not been any services for an infestation of bed bugs since the start of the 2021 year. The Administrator stated that the monthly pest control services includes treating for bed bugs and that the facility staff also uses a special spray to prevent bed bugs.

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

A telephonic exit interview was conducted with Administrator Gregory Restum and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC9099 (FAS) - (06/04)

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