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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004456
Report Date: 09/09/2021
Date Signed: 09/10/2021 12:52:24 PM

Unsubstantiated


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
08/04/2021 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210804114748
FACILITY NAME:VILLA LURENFACILITY NUMBER:
306004456
ADMINISTRATOR:BRIAN BUENVIAJEFACILITY TYPE:
735
ADDRESS:13749 E. CREWE STREETTELEPHONE:
(562) 941-3813
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:62CENSUS: 58DATE:
09/09/2021
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Brian Buenviaje TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility has rodents
Communications by resident's representative to the facility are not answered promptly and completely
Inadequate Food Service
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted another visit to deliver the final results of the investigation. LPA met with Administrator, Brian Buenviaje who assisted with today's visit.

Regarding the allegation that the facility has rodents. The investigation consisted of tour of facility, review of pest control invoices, interviews with Administrator, Assistant Administrator, Staff #1, and Resident #1- Resident #5. Staff interviewed denied the allegation. They stated that they have not observed any rodents at the facility. Residents interviewed were unable to corroborate the allegation. Four out of Five residents interviewed, stated that they have not seen rodents at the facility. LPA did not observe any rodents while conducting the inspection. Regarding the allegation that communications by resident's representative to the facility are not answered promptly and completely, the investigation consisted of interviews with Administrator, Assistant Administrator, Staff #1, and Resident #1- Resident #5. Staff interviewed denied the allegation. Staff stated that they communicate with resident's representative in a timely manner. Residents interviewed were unable to corroborate the allegation. They stated that the facility staff are responsive, and communicate promptly. Residents interviewed stated they had no concerns with communication.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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 5
Control Number 28-AS-20210804114748
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 LUREN
FACILITY NUMBER: 306004456
VISIT DATE: 09/09/2021
NARRATIVE
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Regarding the allegation that the facility provides inadequate food service, the investigation consisted of: review of staff and resident roster(s), review of facility menu(s), tour of facility kitchen, including supply of perishable and non-perishable food, and interviews with Assistant Administrator, Staff #1, and Resident #1- Resident #5.

Review of facility food supply and facility menu(s) indicate that the facility had an adequate supply of perishable of non-perishable food. Interviews with Assistant Administrator, and Staff #1 indicated that the facility does provide residents with adequate meals. Interviews with Residents #1- Resident #5 indicated that the facility serves adequate meals, and the portion size is also adequate.

Based on LPA's observations and interviews, investigation revealed: Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview conducted and copy of report was provided to Administrator.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
08/04/2021 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210804114748

FACILITY NAME:VILLA LURENFACILITY NUMBER:
306004456
ADMINISTRATOR:BRIAN BUENVIAJEFACILITY TYPE:
735
ADDRESS:13749 E. CREWE STREETTELEPHONE:
(562) 941-3813
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:62CENSUS: 58DATE:
09/09/2021
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Brian BuenviajeTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has bed bugs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Angelica Rea conducted another visit to deliver the final results of the investigation. LPA met with Administrator, Brian Buenviaje who assisted with today's visit.

Regarding the allegation that the facility has bed bugs, the investigation consisted of tour of facility, interviews with Administrator, Assistant Administrator and Staff #1, interviews with Resident #1- Resident #5, review of recent pest control invoices, and review of photographs obtained. Administrator stated that the facility does not currently have a bed bug infestiation, however there have been recent reports of bed bugs in 3 rooms. He stated that they are being proactive and have a contract with a pest control company and also have a protocol in place if they have any incidents of bed bugs at the facility. Assistant Administrator, and Staff #1 stated that the facility does have bed bugs. Residents interviewed corroborated the allegation. Four out of five residents interviewed stated that the facility has bed bugs.

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20210804114748
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 LUREN
FACILITY NUMBER: 306004456
VISIT DATE: 09/09/2021
NARRATIVE
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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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20210804114748
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 LUREN
FACILITY NUMBER: 306004456
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/21/2021
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 will maintain a contract with pest control company to address the bed bug problem, until the facility is free of bed bugs. Pest control company is to tour entire facility to observe which room(s) have bed bug activity. Administrator will provide LPA 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: Staff and Resident interviews, Assistant Administrator, Staff #1 and 4 out of 5 residents interviewed stated that there are bed bugs at the facility.
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Administrator will comply with all recommendations given by pest control company, including replacing resident mattresses, if that is needed. Administrator will ensure that first visit is conducted by 9/21/21, 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: 09/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5