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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601940
Report Date: 06/29/2021
Date Signed: 06/29/2021 06:02:32 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, 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
05/21/2020 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200521161019
FACILITY NAME:VILLA FLORAFACILITY NUMBER:
198601940
ADMINISTRATOR:ROSALINDA BUENVIAJEFACILITY TYPE:
735
ADDRESS:10932 CARMENITA RD.TELEPHONE:
(562) 941-5249
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:34CENSUS: 31DATE:
06/29/2021
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Joel AlonzoTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility has bed bugs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted another visit in regards to the above mentioned allegation. The investigation consisted of interviews with Administrator, Staff, #1, Staff #2, and Resident #1-Resident #4. Administrator was interviewed on 5/28/20, and denied that there was a bed bug problem at the facility. Staff interviewed were unable to corroborate the allegation. Staff #1 stated that he was not aware of a bed bug problem at the facility. Staff #2 stated that a couple of residents have said that they have seen bed bugs, and those residents have been moved to another room. 4 out of 4 residents interviewed on 6/29/21 stated that there are bed bugs in their room(s). Resident #3 stated that he had a trap full of dead bed bugs in his room. LPA observed trap with dead bed bugs on today's visit. Resident #4 pulled up pant legs to show LPA numerous marks on her legs, and stated that they were bed bug bites.

Based on LPA's observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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 2
Control Number 28-AS-20200521161019
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA FLORA
FACILITY NUMBER: 198601940
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2021
Section Cited
CCR
80087(a)(1)
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(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.
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Administrator/Licensee shall ensure that the facility is free of bed bugs. Licensee will obtain contract with pest control company until the facility is free of bed bugs. Licensee will provide LPA Rea with detailed monthly reports, until the facility is free of bed bugs.
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This requirement has not been met as evidenced by: Resident interviews, and LPA observations. 4 out of 4 residents interviewed stated that there are bed bugs at the facility. LPA observed dead bed bugs in a tray provided by Resident #3.
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Licensee will comply with all recommendations given by pest control company, including replacing resident mattresses, if that is needed. Licensee will ensure that first visit is conducted by 7/7/21, and will send copy of report to LPA.
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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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2