306005908-1-19-2023-22-AS-SSAS-CN9SVF-20230120131239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005908
Report Date: 01/19/2023
Date Signed: 01/19/2023 02:41:07 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/17/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230117131158

FACILITY NAME:	WESTMONT OF CYPRESS		FACILITY NUMBER:	306005908
ADMINISTRATOR:	PATRICK FRAZIER		FACILITY TYPE:	740
ADDRESS:	4889 & 4775 KATELLA AVE.		TELEPHONE:	(858) 729-6720
CITY:	LOS ALAMITOS	STATE: CA	ZIP CODE:	90720
CAPACITY:	152	CENSUS: 136	DATE:	01/19/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Patrick Stewart, Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not prevent an infestation of bed bugs

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of investigating the allegation listed above. LPA was greeted and granted entry by Patrick Frazier, Executive Director after explaining the purpose of the visit and detailing the allegation.

LPA requested, obtained and reviewed the resident records for individuals living in both units mentioned in the initial complaint (Rooms 225 and 228 respectively), as well as the facility census with room assignments, staff roster and pest control records. LPA conducted four (4) staff interviews and interviewed resident R1's Durable Power of Attorney as well as conducted a tour of the affected unit.

The investigation into the allegation listed above revealed the following: During the first half of December 2022, caregivers on the night shift noticed the presence of what was alleged to be bed bugs inside unit 225. Staff in question communicated their concerns to the morning shift staff who conducted a body check on the resident and a search for the presence of bed bugs in the room. CONTINUED ON FORM LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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 22-AS-20230117131158

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WESTMONT OF CYPRESS	FACILITY NUMBER: 306005908
	VISIT DATE: 01/19/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099
The presence of bites on the resident's legs was confirmed and reported to the Resident Services Director and Executive Director immediately. No reports of the infestation were made to the Department prior to the visit being conducted, but a post-dated report was submitted during the visit by the facility's nurse.

Leadership staff reached out to the facility's contracted exterminator service who scheduled a treatment protocol for the affected room and adjacent units starting on December 14, 2022. The protocol involved three weekly interventions that were concluded on January 3rd, 2023 for all six units involved (to the left, right, above and below the affected unit), followed by a canine inspection scheduled on January 18, 2023. Prior to the chemical interventions, facility staff removed all the resident's belongings from closets and cabinets and stored them into containers that had been acquired by the facility's maintenance staff. All outlet covers were also removed and the adjacent units walls were cleared off of any belongings as well. No evidence of bed bugs outside of the affected unit were found by the exterminator service.

The report for the canine inspection was provided to LPA by the facility and concluded that live bed bugs were still present in the resident's wooden bed frame. A follow-up intervention will occur on Monday January 23, 2023 after which the resident's daughter will remove the bed from the premises and replace it. At this time, care staff has not been able to witness newly occurring bites on resident R1.

Regarding the second alleged affected unit, LPA reviewed resident records that showed the unit to be vacant from November 30, 2022 until December 31, 2022 after the resident living in the unit moved out. The resident in question had complained of potential bite marks that were confirmed to be an unrelated rash. No live or dead bed bugs were found in the unit in question. A new resident moved into the unit on December 31, 2022 and no evidence of the presence of bugs has been found at this time.
LPA accompanied by administrator toured the affected unit #225 during the visit. No evidence of live bed bugs were observed. LPA observed the presence of a large wooden bed frame and headboard with storage drawers underneath. The drawer were live bugs were found following the canine inspection was observed to have been placed into a plastic bag to avoid further contamination.

The allegation that Staff did not prevent an infestation of bed bugs is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report along with a Technical Advisory on Reporting Requirements was left at the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

LIC9099 (FAS) - (06/04)

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