216801999-9-11-2024-21-AS-VBEI-D96PY7-20240916114328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216801999
Report Date: 09/11/2024
Date Signed: 09/11/2024 10:58:48 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/01/2024 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20240801154438

FACILITY NAME:	SAINT MICHAEL'S EXTENDED CARE		FACILITY NUMBER:	216801999
ADMINISTRATOR:	ZINGKHAI, RUFUS		FACILITY TYPE:	740
ADDRESS:	416 4TH STREET		TELEPHONE:	(415) 453-4600
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	44	CENSUS: 36	DATE:	09/11/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Staff Member, Sheila Manansala, and Licensee, Ria Garrison		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Licensee did not keep the facility free of pests

INVESTIGATION FINDINGS:

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At approximately 10:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for this Complaint Investigation regarding the above allegation and met with Staff Member, Sheila Managsala. Administrator, Rufus Zingkhai, was available by telephone. Licensee, Ria Garrison, arrived during visit at approximately 10:45AM.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. There is an allegation of “Licensee did not keep the facility free of pests.” Complainant stated that residents were observed to have bed bugs and bed bug bites on them, and that bed bugs were seen crawling from facility furniture on 07/26/2024. Complainant also stated that on 09/04/2024, bed bugs or cockroaches were observed in a resident’s room and under facility furniture.Interviews conducted with involved parties stated that during a visit on 07/30/2024, bed bugs were not seen or observed.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

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 21-AS-20240801154438

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SAINT MICHAEL'S EXTENDED CARE	FACILITY NUMBER: 216801999
	VISIT DATE: 09/11/2024

NARRATIVE

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Continued from LIC9099

Interviews conducted with facility staff, Administrator, and Licensee, stated that they have not seen any bed bug activity. Review of facility progress notes dated 07/25/2024 to 08/06/2024 did not notate any concerns regarding bedbugs. Review of Pest Control Inspector visit dated 08/21/2024, stated that there was no bed bug activity at the facility. Interview conducted with Administrator acknowledged that the facility has an ongoing cockroach issue and that the facility has routine visits from Pest Control to monitor and inspect for pests such as bedbugs and cockroaches. Review of Pest Control Service Agreement corroborates monthly treatment and review of facility receipts indicated that Pest Control visited facility on 08/13/2024 for inspection and monitoring. LPA was informed that Pest Control is scheduled to come back for another visit on 09/23/2024. Based on document review, interviews conducted, and observations made, this allegation is Unsubstantiated.

A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Licensee. Signature on form confirms receipt of documents.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC9099 (FAS) - (06/04)

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