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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370804404
Report Date: 07/19/2021
Date Signed: 07/26/2021 11:03:33 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2021 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20210630150234
FACILITY NAME:SILVERCREST GUEST HOMEFACILITY NUMBER:
370804404
ADMINISTRATOR:PELINA, AMALIAFACILITY TYPE:
740
ADDRESS:960 GROSSMONT AVENUETELEPHONE:
(619) 442-3957
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:15CENSUS: 12DATE:
07/19/2021
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Licensee, Amalia PelinaTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Facility is following unsafe food practice.
Facility has insects.
Facility is malodorous.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver findings regarding the above-mentioned allegations. LPA met with Licensee Pelina, identified herself, and stated the purpose of the visit.

The Department’s investigation consisted of outside source and staff interviews, as well as, a facility tour to obtain documentation and pictures of observations. LPA also secured pertinent records.

It was alleged the facility is not following safe food practices. The facility tour revealed the kitchen was unsanitary and in a state of disarray. LPA observed large amounts of exposed or unsealed food items left out in the kitchen, some of which were expired and/or rotten. It was also alleged the facility has pests. During the facility tour LPA observed several insects in the kitchen and more throughout the facility. LPA opened the refrigerator and freezer doors and observed several pests scurry away. An interview with the Licensee revealed the facility has a contract with a pest control agency. An outside source revealed the pest control sprays the exterior of the facility four times a year which is to prevent pests from entering the premises.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
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 4
Control Number 08-AS-20210630150234
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SILVERCREST GUEST HOME
FACILITY NUMBER: 370804404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2021
Section Cited
CCR
87555
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General Food Service Requirements: All food shall be...stored...in a safe and healthful manner (b) (27) All kitchen areas shall be..clean and free...vermin and insects. This requirement is not met as evidence by:
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Licensee Pelina will clean the kitchen to include but not limited to; emptying shelves to organize and clean dishes and pots and pans. Licensee Pelina will also remove all expired or rotten food, and maintain date labels on food for tracking purposes. LPA will conduct a follow up visit by POC date.
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Based on interviews and observations the Licensee did not store food in a healthful manner. This poses a potential health risk to all 12 out 12 residents in care.
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Type B
08/02/2021
Section Cited
CCR
87555
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General Food Service Requirements: All food shall be...stored...in a safe and healthful manner (b) (27) All kitchen areas shall be..clean and free...vermin and insects. This requirement is not met as evidence by:
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Licensee Pelina had pest control conduct a full interior pesticide treatment in the kitchen on 7/12/2021. Licensee will monitor facility for any re-infestation and schedule another treatment by Pest Control. LPA will conduct a follow up visit by POC date.
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Based on interviews and observations the Licensee did not ensure a pest free kitchen. This poses a potential health risk to all 12 out 12 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.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20210630150234
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SILVERCREST GUEST HOME
FACILITY NUMBER: 370804404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2021
Section Cited
CCR
87555
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Maintenance and Operation (a) The facility shall be...sanitary and in good repair at all times...for the safety and well-being of residents, employees and visitors. (a) (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidence by:
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Licensee will create a schedule for daily cleaning in the hallway restrooms and require assigned cleaning staff to sign off after cleaning is complete for tracking purposes. LPA will conduct follow up visit by POC due date.
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Based on observations resident restroom had a potent odor of urine that was observed lingering through the facility hallways. This poses a potential health risk to all 12 out 12 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.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20210630150234
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SILVERCREST GUEST HOME
FACILITY NUMBER: 370804404
VISIT DATE: 07/19/2021
NARRATIVE
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It was also alleged the facility is malodorous. During the facility tour LPA opened the door to a facility restroom that had a potent odor of urine which lingered throughout the facility hallways. During the facility tour LPA also observed the kitchen was malodorous.

Based on observations and interviews, the above allegations are determined to be substantiated. A substantiated finding means the allegations are valid because the preponderance of the evidence standard has been met. Deficiency is cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on the LIC 9099-D.

An exit interview was conducted with Licensee Pelina and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Licensee Pelina . An electronic email read receipt confirms the documents were received.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4