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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609014
Report Date: 03/29/2022
Date Signed: 03/29/2022 05:39:09 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/03/2020 and conducted by Evaluator Tihesha Smith
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20200703091019
FACILITY NAME:EL MOLINO MANORFACILITY NUMBER:
197609014
ADMINISTRATOR:PASCASIO, GLORIAFACILITY TYPE:
735
ADDRESS:2544 N EL MOLINO AVENUETELEPHONE:
(626) 639-4270
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:36CENSUS: 29DATE:
03/29/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Zeph PascasioTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff failed to keep the facility free from bed bugs
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Lynn Smith and Gary Tan conducted a subsequent investigation for the allegation listed above. LPAs met with staff Zeph Pascasio and explained the reason for the visit. Administrator Gloria Pascasio was contacted and designated Zeph Pascasio to sign the report.
It was alleged that a resident’s room had bed bugs.

LPA Lefian conducted the initial virtual visit on 07/09/2020 at 2:00 PM. LPA Lefian interviewed resident, administrator and conducted virtual physical plant tour and requested facility documents relevant to the investigation.

During today’s visit, LPAs conducted physical plant tour at 11:35 AM and inspected eight (8) random rooms, requested facility documents at 10:00 AM and conducted interview with the staff and resident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
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 31-AS-20200703091019
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: EL MOLINO MANOR
FACILITY NUMBER: 197609014
VISIT DATE: 03/29/2022
NARRATIVE
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(Cont from 9099)

LPA Lefian’s interview with the resident on 07/09/2020 revealed that upon learning of the bed bugs, residents were transferred to another room and pest control called to treat the rooms suspected of bed bugs. LPAs interview with staff today at 12:00 PM revealed that all beds and box springs are now enclosed within zippered plastic protective casings to avoid further infestation of bed bugs. On random room inspections LPA’s confirmed that all beds and box springs are enclosed within plastic casings.

LPA’s record review today at 10:30 AM revealed that the facility has contracted a pest control company that periodically conducted follow-up treatment visits to the facility to avoid any new infestations.

Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2