198204399-6-16-2021-11-AS-MCAA-C5TPM5-20210812112542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204399
Report Date: 06/16/2021
Date Signed: 06/16/2021 04:00:22 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 DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2021 and conducted by Evaluator Jade Jordan

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210607080331

FACILITY NAME:	VILLA REDONDO CARE HOME		FACILITY NUMBER:	198204399
ADMINISTRATOR:	MARIA BRAVO		FACILITY TYPE:	740
ADDRESS:	237 REDONDO AVENUE		TELEPHONE:	(562) 434-9931
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90803
CAPACITY:	80	CENSUS: 39	DATE:	06/16/2021
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Lorraine Avelino		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility has roaches.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jade Jordan initiated a 10- day complaint investigation and delivered findings for the allegation listed above. During today’s visit, LPA Jorda met with Assistant Administrator, Lorraine Avelino, and was later joined by administrator, Maria Bravo and explained the reason for the visit.

Investigation Consisted of the following: Physical Plant tour, Record Review, and Interviews with staff and residents.

The following documents were requested: Pest Control Treatment Plan; Pest Control Logs, Resident Roster and Face sheet, and Staff Roster.

Continued on 9099 C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

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 11-AS-20210607080331

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA REDONDO CARE HOME	FACILITY NUMBER: 198204399
	VISIT DATE: 06/16/2021

NARRATIVE

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Based on The Allegation: Facility has roaches.

During the Physical tour, LPA Jordan observed the kitchen to be in title 22 regulation. LPA Jordan did not observe bugs(cockroaches) in kitchen floors, refrigerator, sinks or microwave. LPA Jordan did not observe any bugs/roaches in the hallways, elevators, or common areas. The administrator stated that she has not received any complaints from the residents or staff about cockroaches and has a pest control treatment plan in place. Based on Record Review the Pest technician comes out every other week and treats different areas of the facility. It was observed that the Kitchen Specifically has been treated. Administrator provided LPA with Logs of dates and areas treatment plan is conducted. The Kitchen staff stated that he cleans, and disaffects after every food prep, Approximately 3x’s a day, and states there is a pest control man who comes out and sprays. Assistant Administrator stated that the kitchen is deep cleaned once a month. This includes floors, Refrigerators and shelving. Staff 1-3 revealed during their interviews that they have observed cockroaches or other bugs here and there, around the facility during heat waves. Cockroaches specifically have not been spotted recently in the kitchen, and all staff generally declined seeing any cockroaches in the microwaves, or residents’ rooms. Dates of sightings could not be recalled.

Based On Lpa Observation, Record Review, and Interviews conducted. The Department finds that:
" 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. "

No Citations issued and an Exit interview was conducted and a copy of this report was given to Administrator.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC9099 (FAS) - (06/04)

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