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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602620
Report Date: 10/17/2024
Date Signed: 10/17/2024 02:43:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/14/2024 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241014124023
FACILITY NAME:LONG BEACH RESIDENTIALFACILITY NUMBER:
198602620
ADMINISTRATOR:CRYSTAL BARRIENTOSFACILITY TYPE:
735
ADDRESS:4201 EAST 10TH STREETTELEPHONE:
(562) 433-2455
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:49CENSUS: 49DATE:
10/17/2024
UNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Anthony Griffin/AdministratorTIME COMPLETED:
02:42 PM
ALLEGATION(S):
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Facility staff does not ensure facility is kept free of bed bugs resulting in clients getting bitten
INVESTIGATION FINDINGS:
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On 10/17/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Anthony Griffin /Administrator. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Client’s interviews (C#1-C#8) and Witness interview(W#1) and a Health and Safety Check of the facility. LPA Iniguez gathered the following documentation: copies of resident roster, staff roster, pictures of pest control contract and pictures taken of client’s room.


Evaluation Report continues LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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 4
Control Number 11-AS-20241014124023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: LONG BEACH RESIDENTIAL
FACILITY NUMBER: 198602620
VISIT DATE: 10/17/2024
NARRATIVE
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Investigation Revealed the Following:

Allegation: Facility staff does not ensure facility is kept free of bed bugs resulting in clients getting bitten

The details of the complaint alleged that the facility staff does not ensure facility is kept free of bed bugs resulting in clients getting bitten.



During a tour of the facility, LPA observed the presence of bed bugs on the client’s mattresses in room numbers 24 and 25. LPA Iniguez took a picture as evidence.

During the records review, LPA Iniguez reviewed the following: LPA observed copies of the pest control company. On 9/27/24, they came to treat room numbers 5 and 28 for bed bugs, and on 10/9/24, they came to treat room numbers 1, 3, 4, 9, 10, and 11. In addition, LPA Iniguez reviewed the facility complaint history on FAS. There are 2 complaints with the same allegation that have been substantiated on 7/29/19 and 3/6/23.

During an Interview with the Administrator (A#1), he stated that the facility has been treated for bed bugs at least twice per month or as requested. (A#1) is aware of the bed bugs problem, but he stated that housekeepers also do a thorough check every time they go inside clients' rooms, including the clients' mattresses. If bed bugs are present, they will use the in-house chemicals to treat them.

During interviews with clients (C#1-C#8), (2) out of (8) stated that they do have bed bugs in their rooms, (6) out of (8) stated they do not have seen bed bugs in a while.

During an interview with Witness 1 (W#1), they stated that they come to treat the building for bedbugs twice monthly.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20241014124023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: LONG BEACH RESIDENTIAL
FACILITY NUMBER: 198602620
VISIT DATE: 10/17/2024
NARRATIVE
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During this investigation, LPA found sufficient evidence to support the above-mentioned allegation.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D.

An exit interview was conducted, and a copy of the Complaint Report was given to Anthony Griffin /Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20241014124023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: LONG BEACH RESIDENTIAL
FACILITY NUMBER: 198602620
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2024
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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Licensee will ensure facility is free of pests at all time. As plan of correction, licensee will increase amount of times pest control company will come on a montly basis and educate housekeepers about the presence of bed bugs. POC correction will be sent to LPA via email before POC due date.
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Based on a review of records and interviews, the facility staff failed to ensure faclity is free of bed bugs on client's rooms.

This poses an immediate health and safety risk to all residents in care.
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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: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4