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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340308207
Report Date: 07/15/2024
Date Signed: 07/15/2024 11:35:55 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/09/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240709164336
FACILITY NAME:SACRAMENTO GUEST HOMEFACILITY NUMBER:
340308207
ADMINISTRATOR:MANGABAT, NORMINIOFACILITY TYPE:
740
ADDRESS:2715 G ST.TELEPHONE:
(916) 447-1502
CITY:SACRAMENTOSTATE: CAZIP CODE:
95816
CAPACITY:13CENSUS: 12DATE:
07/15/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gladys MangabatTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility staff are not taking sufficient measures to address bed bug infestation
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Vincent Moleski and Holly Williams arrived unannounced to open this complaint investigation. LPAs Moleski and Williams met with licensee Gladys Mangabat and explained the purpose of the visit.

This investigation consisted of interviews, observation, and record review. LPAs Moleski and Williams interviewed Mangabat, a resident (R1), a resident's responsible party (R1's RP), and a pest control contractor.

Mangabat had been aware of a bed bug infestation since around mid-June. Mangabat said she had contracted with a pest control company to have monthly chemical sprayings done. Mangabat also said she had implemented several additional pest control measures, including encasing residents' mattresses, performing hot-water laundry services, localized heat treatments with a heat gun, and enhanced environmental cleaning with alcohol-based solution. [continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
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 2
Control Number 27-AS-20240709164336
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SACRAMENTO GUEST HOME
FACILITY NUMBER: 340308207
VISIT DATE: 07/15/2024
NARRATIVE
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LPAs Moleski and Williams toured the facility and observed mattresses which had been encased. In an interview, a pest control contractor confirmed having performed chemical treatments on or around June 26, 2024 and confirmed that a representative will be returning to this facility on or around July 28, 2024.

In an interview, R1 said that after they had mentioned the infestation to Mangabat, that Mangabat quickly took measures to mitigate the situation. R1 said that Mangabat helped to clean R1's room, and encased R1's mattress, and performed heat treatments in R1's room. R1 said that they are not being bitten any more after the pest control company visited.

LPA Moleski reviewed a contract between Mangabat and the pest control company dated June 11, 2024. The contract did not include a termination date. Mangabat said she would be retaining these services monthly on an ongoing basis.

The department has determined the following as it relates to the allegation that facility staff are not taking sufficient measures to address bed bug infestation:

Based on interviews, observation, and record review, the above allegation is UNSUBSTANTIATED, which means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies were cited regarding the above allegations. An exit interview was held and a copy of this report was left with Mangabat.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2