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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370804404
Report Date: 07/22/2022
Date Signed: 07/22/2022 04:44:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
07/15/2022 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20220715113436
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: 11DATE:
07/22/2022
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Amalia Pelina, LicenseeTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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-Facility is not addressing vermin infestation
-Facility not cleaned properly
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced complaint investigation visit at the facility to deliver findings. LPA displayed his department identification, introduced himself and was permitted into the facility. Amalia Pelina, Licensee met LPA Pena who explained the purpose of the visit and reviewed the basic elements of the complaint. On 07/15/22, it was alleged that the facility did not address a vermin infestation and the facility was not being adequately cleaned.

The Department’s investigation included touring of the physical plant, staff, residents and outside sources interviews and obtaining copies of facility, resident and outside source records.

On 7/21/22, while inspecting the resident rooms, LPA witnessed active bedbug and cockroach infestations. Live and dead bedbugs were observed moving in and about resident bedding, floors, walls, blinds and furniture. Live and dead bedbugs and red markings were observed on resident bedding. A white powder was observed on the floor which was covered by numerous dead bedbugs. LPA also
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
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 6
Control Number 08-AS-20220715113436
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SILVERCREST GUEST HOME
FACILITY NUMBER: 370804404
VISIT DATE: 07/22/2022
NARRATIVE
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observed live and dead cockroaches in resident rooms, kitchen, main hallway and inside the refrigerator. LPA opened a pantry cabinet to inspect food supplies and observed a live rodent actively feeding in a bag of rice. Also seen in this same pantry was rodent waste among the non-perishable food supplies. LPA observed glue traps set throughout the facility including the kitchen area.

LPA also observed several areas in the facility, including the office and resident rooms that were cluttered with papers, trash and food items. Many resident rooms had unwrapped food items. The kitchen counters, cabinets and shelves were covered with food wrappings, vegetables and fruits, sealed and opened food items as well as clean and soiled pots, pans and utensils. The sink had soiled dishes, utensils, food, and standing water.

The licensee admitted to having a long-term infestation of bedbugs and cockroaches. The licensee said she had not contacted a pest control service to address the rodents. Licensee believed once a plumbing problem on the first floor of the residence is repaired the mice will leave. The licensee said they had a pest control service spray the facility for insects in May 2022, however, the pest control service only sprayed the outside areas and not inside the facility.

An outside source indicated the licensee had a pest control technician perform an inspection of the residence in June 2022. Outside source documentation indicated evidence of cockroach and rodent activity inside the interior. Outside source documentation stated “numerous sanitation issues leading to infestation. Rodent droppings also observed in home.” Per the licensee, treatment was not contracted with the company as she was not satisfied with the May service. Prior to LPA leaving the facility on 7/21/22, the licensee cleaned the kitchen, changed some of the resident bedding, and removed trash, dead insects and rodent waste.

On 7/22/22, a pest management service technician conducted a second evaluation of the facility and confirmed that the residence is currently infested with cockroaches and bedbugs. Documentation reported active cockroach and rodent activity inside the residence as well as standing water on the first floor. The standing water has developed into a mosquito infestation.
The Department has investigated the allegations that the facility is not addressing a vermin infestation and not cleaning the facility adequately. Based on LPA direct observation, interviews with residents, staff and outside sources, and records review, there is sufficient evidence to meet the preponderance of evidence
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 08-AS-20220715113436
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SILVERCREST GUEST HOME
FACILITY NUMBER: 370804404
VISIT DATE: 07/22/2022
NARRATIVE
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standard. Therefore, the above allegations are deemed to be Substantiated. Deficiencies are noted under California Code of Regulations, Title 22, Division 6, Chapter 8, and are being cited on the attached LIC9099D form.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Licensee, Pelina. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Administrator Pelina at the conclusion of the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
07/15/2022 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20220715113436

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: 11DATE:
07/22/2022
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Amalia Pelina, LicenseeTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility not providing a comfortable temperature for residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced visit to conclude the aforementioned complaint investigation. The Department’s investigation consisted of LPA observations, review of facility records, and interviews with clients, facility staff, and outside sources.

On 07/15/22, it was alleged that the facility did not provide comfortable temperatures, specifically during the winter months. During the investigation, LPA observed that the air temperature inside the facility ranged between 80-82 degrees Fahrenheit. The documented air temperature in El Cajon on these two days ranged between 90-91 degrees Fahrenheit. Resident interviews revealed no complaints that the facility temperatures were uncomfortable. Residents did not report temperatures being too cold in the winter or too hot in the summer.

LPA did not observe any fans and curtains were used to block some of the sun and provide shade inside the residence. Resident’s were not sweating, flushed or appeared to be overheated. When asked, the licensee said the facility has centralized air but admittedly doesn’t use it unless temperatures are too
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 08-AS-20220715113436
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SILVERCREST GUEST HOME
FACILITY NUMBER: 370804404
VISIT DATE: 07/22/2022
NARRATIVE
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hot or cold. LPA asked licensee to turn on the air handlers and noted that the system was operating..

The investigation did not yield sufficient evidence to conclude that the facility does not provide a comfortable temperature for residents. Based upon a lack of evidence to conclude that the above mentioned occurred, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Licensee, Pelina, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to staff at the conclusion of the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20220715113436
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SILVERCREST GUEST HOME
FACILITY NUMBER: 370804404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/27/2022
Section Cited
CCR
87307
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87307...Personal Accommodations and Services. (d)...safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by:
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Licensee agreed to obtain professional pest control service to address bedbug, cockroach, mosquito and rodent infestations. Licensee to provide CCLD copy of contract for services by the POC due date.
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LPA, resident,outside source observation and interviews confirmed bedbug, cockroach, mosquito and rodent infestations inside the facility which poses an immediate threat to all eleven residents in care.
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Type B
08/05/2022
Section Cited
CCR
87303
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87303 Maintenance and Operation...
(a) The facility shall be clean, safe, sanitary and in good repair at all times. ...for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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Licensee agreed to hire staff to assist with cleaning and logging activity. Licensee to immediately launder bedding and purchase mattress covers. Licensee to update facility rules so food items are not allowed in resident rooms and residents must change clothing before entering the facility after going out to community. Licensee to provide copy of facility rules and receipts by POC due date.
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LPA observations, record reviews and interviews confirmed resident rooms, kitchen and hallways contained cockroaches, bedbugs, trash, soiled utensils, food items, and rodent waste which pose an immediate threat to all eleven 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: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6