374600661-6-17-2021-08-AS-SJAB-C7BVPM-20210929163654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600661
Report Date: 06/17/2021
Date Signed: 06/17/2021 04:36:41 PM

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
06/11/2021 and conducted by Evaluator Alexandre Vo

COMPLAINT CONTROL NUMBER: 08-AS-20210611114718

FACILITY NAME:	CALIFORNIA HOME FOR SENIORS		FACILITY NUMBER:	374600661
ADMINISTRATOR:	GLORIA S. QUILLOPE		FACILITY TYPE:	740
ADDRESS:	1061 E. BRADLEY AVENUE		TELEPHONE:	(619) 448-2870
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	15	CENSUS: 9	DATE:	06/17/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Caregiver, Priscilla Dizon		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility has bed bugs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Alexandre Vo, conducted an unannounced complaint visit regarding the above-mentioned allegation. LPA was allowed entry into the facility by staff Priscilla Dizon, after identifying himself and stating the purpose of the visit.

During the visit, LPA toured the facility, reviewed facility records, and inspected the physical plant. LPA inspected all 15 mattresses in the nine bedrooms and observed no evidence of bed bugs. Interviews with residents and staff indicate that residents had rashes but they did not observe any bed bugs. Based on observations and interviews, the complaint is unfounded, which means that the allegation is false, could not have happened, or without a reasonable basis.

An exit interview was conducted. A copy of this report and Licensee's Rights (9058 01/16) were provided to the Licensee by electronic mail. Staff Dizon signature confirms that the report was read to the facility representative. A confirmation receipt was requested from the Licensee.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alexandre Vo	TELEPHONE: (619) 385-7506
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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