198601502-4-28-2023-28-AS-RORN-CT3UNY-20230623154442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601502
Report Date: 04/28/2023
Date Signed: 04/28/2023 11:35:01 AM

Unsubstantiated

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
04/20/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230420125629

FACILITY NAME:	RAYMOND HOUSE		FACILITY NUMBER:	198601502
ADMINISTRATOR:	HAMILTON, DAVID		FACILITY TYPE:	735
ADDRESS:	872 N RAYMOND AVE		TELEPHONE:	(626) 794-4103
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	22	CENSUS: 10	DATE:	04/28/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Vernon Langston		TIME COMPLETED:	11:55 AM

ALLEGATION(S):

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Facility failed to address the pest infestation.
Facility is not reporting scabies outbreak.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint investigation to address the above allegation(s). LPA met with DSP Cerreros Rosio and allowed the entry of the facility and explained the reason of the visit. Shortly after, LPA met with facility administrator Vernon Langston and director of the facility Monique Jordan and assisted LPA with the visit.

The investigation consisted of the following: LPA interviewed two clients in the facility and one client via telephone, licensee, administrator, director of the faciltiy and two staff (S1 and S2) and technician from pest control company and obtained the pest control service report dated on 3/1/23 and 4/15/23.

The investigation revealed of the following: Allegation#1 "Facility failed to address the pest infestation" LPA interviewed clients and reported facility does have roaches once a while but not like infestation. They did see one or two sometiems but not often.
(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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 28-AS-20230420125629

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: RAYMOND HOUSE	FACILITY NUMBER: 198601502
	VISIT DATE: 04/28/2023

NARRATIVE

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LPA interviewed the staff and reported the pest control company ORKIN comes once a month for service and never reported any pest infestation. Staff reported no staff or clients ever complained any pests issues include bed bugs or roaches in the facility. LPA also reviewed the pest control service report and they only serviced for the exterior of the facility. During the tour of the facility, LPA did not observe any roaches or bed bugs in the facility.

Allegation#2 "Facility is not reporting scabies outbreak." LPA interviewed clients and all denied the allegation and reported there's no scabies in the facility. LPA interviewed staff and reported they never had any scabies or scabies outbreak in the facility. Some staff who worked in the facility for a long time and reported they never ever heard any clients or staff had scabies, not even one case. Staff also reported the primary physician comes every 4 weeks to check client's from head and toe and they never mentioned anything about clients had scabies.

Based on the interviews conducted with staff and clients and record review, 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 above allegations are found to be: UNSUBSTANTIATED.

No deficiencies noted nor citations issued.

Exit interview conducted and a copy of this report and appeal right was provided to Administrator Vernon Langston

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC9099 (FAS) - (06/04)

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