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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 371881447
Report Date: 06/06/2024
Date Signed: 06/06/2024 03:36:07 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/17/2024 and conducted by Evaluator Jacqueline Shaw Ross
COMPLAINT CONTROL NUMBER: 18-AS-20240517110825
FACILITY NAME:CASA ZAGARA INC.FACILITY NUMBER:
371881447
ADMINISTRATOR:DOKKEN, GENSKE BRIDGETTFACILITY TYPE:
740
ADDRESS:2043 VISTA VALLE VERDE DRTELEPHONE:
(760) 419-5665
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:6CENSUS: 1DATE:
06/06/2024
UNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Leslie Minchello, Caregiver/Admin AssistantTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Staff not keeping facility free from pests.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, (LPA) Jacqueline Shaw Ross conducted an unannounced visit to deliver findings on the above allegation. LPA met with Leslie Minchello, Caregiver/Admin Assistantwho was informed of the purpose of the visit. During the investigation, LPA interviewed staff and residents, conducted an inspection of the facility, and reviewed facility records. LPA was unable to interview two out of the three residents due to one of the residents passing away and the other resident was unable to communicate.

On 5/17/2024, Community Care Licensing received a complaint investigation stating that staff are not keeping the facility free from pests. Information obtained from staff interviews indicated that the facility has been experiencing bugs, particularly "roly poly bugs," that were on and around the exterior doors and in the garage. Licensees also stated staff reported seeing one mouse under the kitchen sink in April of 2024. Licensees indicated they took preventive measures by contacting a pest control service immediately after the issue was brought to their attention. Documents obtained revealed that in November 2023, while the home was vacant, a service by the pest control was completed. It was advised that due to observing pests, the service was reinstated in April 2024. Licensees signed an annual contract in April for the facility to be serviced monthly and there have been no evidence of bugs since then.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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 18-AS-20240517110825
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CASA ZAGARA INC.
FACILITY NUMBER: 371881447
VISIT DATE: 06/06/2024
NARRATIVE
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LPA interviewed one out of three residents who reported they have not seen any bugs or insects since their arrival. Resident indicated there were no issues or concerns regarding the facility. LPA conducted an inspection of the facility and did not observe any mice, but did observe roly polies on the doorframes, windowsills, and in the garage.

Based on interviews with staff and residents, review of facility documents, and inspection of the facility, there is not enough evidence to support the allegation that staff is not keeping facility free of pest. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Leslie Minchello, Caregiver/Administrative Assistant.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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