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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340317699
Report Date: 11/17/2022
Date Signed: 11/17/2022 01:26:04 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2022 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20220621132239
FACILITY NAME:PRAISE CARE HOMEFACILITY NUMBER:
340317699
ADMINISTRATOR:ARTURO MERCADOFACILITY TYPE:
735
ADDRESS:4600 PARKER AVENUETELEPHONE:
(916) 803-5864
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:36CENSUS: 35DATE:
11/17/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Arturo MercadoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility had bed bugs
INVESTIGATION FINDINGS:
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On 11-17-22 at 11:00am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue complaint investigation for the allegations noted above. LPA met with Administrator Arturo Mercado and explained the purpose of the visit. LPA interviewed facility Administrator and reviewed pest control service records. An interview with staff1 (S1) was conducted by LPA Hubbard on 9-9-22. A pest control agreement from facility was also reviewed by LPA Hubbard on 9-9-22.
LPA Bilger reviewed pest control agreement .Based on interviews conducted, it was revealed that facility had an episode of bed bugs within facility during a time period in July of 2022. Based on record review, it was determined that pest control was notified on 7-8-22 and contracted to service facility for various types of insects. Interviews and record reviews also revealed that pest control serviced facility on 7-29-22, 9-19-22, and 11-4-22 but did not include a specific bed bug treatment service..

{Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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 27-AS-20220621132239
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: PRAISE CARE HOME
FACILITY NUMBER: 340317699
VISIT DATE: 11/17/2022
NARRATIVE
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Based on interviews and record reviews, it was determined that a specific bed bug treatment was performed by a separate service company for bed bug treatment on 7-12-22 after the discovery of bed bugs within facility. Due to reports that facility had an episode of bed bugs, this allegation is SUBSTANTIATED.

Citations are issued today under Title 22, Division 6 and noted on LIC 9099D. An exit interview was conducted with Arturuo Mercado and a copy of this report was left with Arturo. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20220621132239
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: PRAISE CARE HOME
FACILITY NUMBER: 340317699
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2022
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. This requirement was not met as evidenced by:
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Licensee will ensure routine pest control service specific to bed bug prevention be initiated. Copy of updated service agreement reflecting said service to be submitted to LPA by POC due date.
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Based on record reviews and interviews, Bed bugs were present in facility in July 2022, and Licensee did not ensure a on-going bed bug treatment service after the initial bed bug occurrence was discovered. This poses a potential health and safety risk to 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: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4