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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601304
Report Date: 09/26/2025
Date Signed: 09/26/2025 05:01:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
09/23/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250923090357
FACILITY NAME:BAILEY CARE HOME #4FACILITY NUMBER:
198601304
ADMINISTRATOR:SHAWN L. BAILEYFACILITY TYPE:
735
ADDRESS:10413 VULTEE AVE.TELEPHONE:
(562) 622-0806
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:4CENSUS: 4DATE:
09/26/2025
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Jennifer Estrada - House LeadTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Licensee did not ensure facility was free from pests.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent visit regarding the above allegations. LPA met with House Lead Jennifer Estrada and explained the reason for the visit.

The investigation consisted of the following:

LPA toured facility, inspected living room and client bedrooms for insects/bedbugs, interviewed 4 Staff (S1-S4) and 1 Client (C1), obtained copies of and reviewed pest control invoices, and delivered findings on the reoprted allegation.

(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025
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 28-AS-20250923090357
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BAILEY CARE HOME #4
FACILITY NUMBER: 198601304
VISIT DATE: 09/26/2025
NARRATIVE
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The investigation revealed the following:
Allegation: Licensee did not ensure facility was free from pests.
It is alleged that the facility has an ongoing bedbug infestation since the beginning of 2025. LPA inspected each clients bedroom/bedding/mattress and did not observe any bugs or evidence of bedbugs. LPA inspected living room furniture, couch/single couch and brown recliner and LPA observed bedbugs on brown recliner took video and sent the video to the Licensee Shawn Bailey. Although the, pest control invoice dated 8/14/25 that there was no bed bug activity found LPAs observations and google search of what bedbugs look like indicated there are active bedbugs in facility. The 4 staff interviewed stated that clients at facility have not had any bite marks or irritations on skin, Staff 3-4 stated they have been bitten while sitting on recliner, S3 stated they have seen active bedbugs on recliner and during visit S4 saw active bedbugs with LPA during visit. This allegation is Substantiated.

Based on LPAs observations, interviews which were conducted and LPAs observations, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC9099-D. Exit interview held, and a copy of this report and appeal rights were emailed to Licensee - shawnspears70@gmail.com and Executive Director - tfrisbey@bchlaca.com.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250923090357
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BAILEY CARE HOME #4
FACILITY NUMBER: 198601304
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2025
Section Cited
CCR
80087(a)(1)
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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors (1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met as evidence by:
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Administrator/Licensee stated that they will be removing the brown recliner today and will call the pest service to do another treatment to the facility over the weeked. Proof via photos (removal of brown recliner) and written request for pest service to be submitted to LPA via email by POC due date. Additonally a copy of the completed service to be emailed to LPA by 10/1/25.
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During todays visit LPA along side of Staff #4 observed bedbugs on the brown recliner that is located in the living room, all other living room furniture and client mattresses/bedding and there were no observations of bedbugs in those other areas.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3