198203919-10-24-2024-11-AS-RORN-DBMTYA-20241204140827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198203919
Report Date: 10/24/2024
Date Signed: 10/24/2024 10:01:19 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/02/2024 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20241002100204

FACILITY NAME:	TLC GUEST HOME II		FACILITY NUMBER:	198203919
ADMINISTRATOR:	MUQEET "MD" DAABHOY		FACILITY TYPE:	740
ADDRESS:	28024 CALZADA DR.		TELEPHONE:	(310) 548-0898
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	6	CENSUS: 6	DATE:	10/24/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rino Santos		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not properly cleaning the floors
Staff did not ensure the facility was free of pests

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/24/24, the Department conducted a subsequent unannounced visit to the facility listed above. The Department met with House Manager, Rino Santos, and the purpose of today’s visit was explained. During today’s visit the Department toured the facility, and interviewed Resident R4.

On 10/09/24, the Department conducted an initial unannounced complaint visit to the facility listed above. The Department met with House Manager, Rino Santos, and the purpose of the visit was explained. During the initial visit, the Department toured the facility, interviewed Staff S1-S3, interviewed Residents R1 and R2, interviewed Residents R3’s Responsible Person (W1), and received documents pertinent to the investigation. The following documents were received and reviewed Resident Roster, Staff Roster, Terminix receipts, and staff training.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

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 11-AS-20241002100204

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TLC GUEST HOME II	FACILITY NUMBER: 198203919
	VISIT DATE: 10/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff are not properly cleaning the floors
The complaint allegation alleges that staff spray the floors with cleaning product and then uses a dust mop to wipe, the floors are cleaned once a week, and resident contracted bacteria on foot due to floors not being cleaned.
During the facility inspection, the Department observed the facility to be clean and sanitary. All floors and walls were observed clean and in good repair.
During interviews with Staff S1-S3, were asked how often the floors are cleaned, three (3) out of three (3) stated the floors are cleaned daily and multiple times if needed. Additionally, during interviews with Staff S1-S3, were asked how they clean the floor, three (3) out of three (3) stated they use a mop and a cleaning solution with bleach.
During interviews with Residents R1, R2, and R4, where asked if the floors in the facility are kept clean, three (3) out of three (3) stated yes, the floors and the facility are clean.
During an interview with a Resident R3's Responsible Party (W1), was asked if the floors in the facility are kept clean, they stated the whole facility is clean.

Allegation: Staff did not ensure the facility is free of pests

The complaint allegation alleges that the facility has cockroaches.
During the facility inspection, the Department did not observe any insects or residue of insects in the facility.
During record review, the Department received and reviewed copies of receipts from pests control company dated on 03/25/24, 05/04/24, 07/16/24, 07/23/24, and

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20241002100204

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TLC GUEST HOME II	FACILITY NUMBER: 198203919
	VISIT DATE: 10/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

08/17/24. The report indicates they are treating for ants, roaches, and spiders. The most current report indicated there were only dead roaches found.
During interviews with Staff S1-S3, were asked if they have seen cockroaches inside the facility, one (1) out of three (3) stated they have seen a cockroach inside the facility. Additionally, during interviews Staff S1-S3, were asked how they keep the facility free of pests and insects, three (3) out of three (3) stated they make sure it is cleaned and a pest control company comes out twice a month to treat.
During interviews with Residents R1, R2, and R4, were asked if the facility is kept free of insects, three (3) out of three (3) stated they have not seen insects inside the facility.
During an interview with a Resident R3's Responsible Party (W1), was asked if the facility is kept free of insects, they stated they have not seen any insects in the facility.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was was conducted with House Manager, Rino Santos, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3