197609105-8-2-2023-31-AS-NMAN-CUJNX9-20230809105048

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609105
Report Date: 08/02/2023
Date Signed: 08/02/2023 03:30:57 PM

Substantiated

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
04/18/2023 and conducted by Evaluator LaQueena Lacy

COMPLAINT CONTROL NUMBER: 31-AS-20230418101310

FACILITY NAME:	GRANDVIEW, THE		FACILITY NUMBER:	197609105
ADMINISTRATOR:	FLORES, YENI		FACILITY TYPE:	740
ADDRESS:	2211 W 6TH STREET		TELEPHONE:	(213) 380-7000
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90057
CAPACITY:	215	CENSUS: 151	DATE:	08/02/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Yeni Flores		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff does not keep facility free of vermin.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) LaQueena Lacy conducted a subsequent complaint visit for the above allegation on 08/02/2023 at 1:30pm to deliver investigative findings. LPA Lacy met with Administrator Yeni Flores and explained the purpose of the visit.

It is alleged that resident #1 (R1) has roaches and bed bugs in their living space. To investigate the above allegation, LPA requested and obtained copies of facility files and documents including but not limited to the staff and resident rosters, a room fumigation schedule and Global Rodent & Pest invoices at 11:49am. LPA interviewed Administrator and staff at approximately 12:00pm, additional staff and resident interviews were conducted between 1:39pm to 3:46pm. Interviews with ten (10) out of one hundred fifty five (155) residents confirm they have not seen any roaches due to an exterminator visiting the facility weekly. (10) out of (155) have not seen any bed bugs and have not been told by any residents that they have bed bugs.

Continued on 9099C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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 3

Control Number 31-AS-20230418101310

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: GRANDVIEW, THE	FACILITY NUMBER: 197609105
	VISIT DATE: 08/02/2023

NARRATIVE

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During the investigation, LPA and administrator inspected ten (10) random bedrooms. Nine (09) out of (10) bedrooms observed the administrator removed all bed linens, comforters, pillows, and all mattress coverings. A plastic or zippered mattress protector was observed on all mattresses. LPA inspected mattress seams, bed frames and surrounding area of the bed, dresser drawers and cabinets, no bed bugs or roaches were observed during the inspection. At the time of the inspection LPA observed R1 sitting in their bed, R1 then confirmed they did not have bed bugs or roaches. R1 pulled back their comforter to exit their bed and R1, the Administrator and LPA observed bed bugs crawling on R1 and in their bed. Upon record review of weekly pest control invoices dated 03/08/2023 through 04/26/2023 from Global Rodent & Pest Services for cockroaches and monthly bait station maintenance. Although the facility was being treated for roaches, bedbugs were observed during the time of inspection. Based on interviews, observations and record review, there is enough evidence to prove the alleged violation did occur, therefore the allegation is SUBSTANTIATED at this time.

No health and safety hazards are noted during this visit.

Deficiency cited, exit interview conducted and a copy of report and appeal rights issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230418101310

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: GRANDVIEW, THE	FACILITY NUMBER: 197609105
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/02/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/03/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	At the time of the visit the administrator submitted weekly Global Rodent & Pest Services invoices dated 05/03/2023- 07/19/2023 for pest control and bed bug treatment. Administrator will continue current treatment
	8 9 10 11 12 13 14	Based on inspection, observation and record review the licensee failed to ensure the facility was free from bed bugs.	8 9 10 11 12 13 14	until advised by professional and will submit weekly invoices for the month of August to the regional office. This citation is cleared during the visit.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC9099 (FAS) - (06/04)

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