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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600798
Report Date: 06/29/2022
Date Signed: 06/29/2022 07:05:18 PM

Unsubstantiated


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
12/02/2021 and conducted by Evaluator Liliana Silveira
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20211202160031
FACILITY NAME:LYN'S HOME CARE IFACILITY NUMBER:
374600798
ADMINISTRATOR:ABILLE, RUDYARDFACILITY TYPE:
735
ADDRESS:1398-B 4TH AVENUETELEPHONE:
(619) 422-1181
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:6CENSUS: 6DATE:
06/29/2022
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Lead Caregiver Marialourd AbilleTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Licensee did not properly treat bed bugs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Liliana Silveira conducted a complaint investigation visit to deliver findings for the above allegation. LPA Silveira met with Lead Caregiver Marialourd Abille and shared the findings.

On 12/02/21, it was alleged that there were bed bugs at the facility. The Department’s investigation consisted of a tour of the facility, as well as interviews with the licensee, staff and residents. LPA conducted a tour of the physical plant on 12/09/21, which included an inspection of all resident's bedrooms. LPA did not observe any bed bugs on the pillows, mattresses, or sheets in the rooms. LPA also observed that all mattresses and mattress boxes had new vinyl covers and were clean. Interviews with the Administrator and staff revealed that a bed bug problem had been reported to the facility by Client #1 (C1) on 09/02/21 and the concern was addressed right away. Bed bug chemicals and powder were spread throughout the facility, mattresses were cleaned weekly with hot water and all linens were washed weekly. LPA observed the products used for the bed bugs at the facility. Interviews with clients also indicated that no one had witnessed or had been affected by any bed bugs at the facility recently.

There was no evidence at the time of the investigation of a bed bug infestation. The above allegation is determined to be unsubstantiated. (continued on next page, LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
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 2
Control Number 08-AS-20211202160031
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: LYN'S HOME CARE I
FACILITY NUMBER: 374600798
VISIT DATE: 06/29/2022
NARRATIVE
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A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2