374604304-12-17-2021-08-AS-DPOL-CABMZS-20220103090338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604304
Report Date: 12/17/2021
Date Signed: 12/17/2021 01:52:45 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
01/12/2021 and conducted by Evaluator Kristina Ryan

COMPLAINT CONTROL NUMBER: 08-AS-20210112081744

FACILITY NAME:	BLUE SKIES OF OCEANSIDE		FACILITY NUMBER:	374604304
ADMINISTRATOR:	AQUINO, RODELIO D.		FACILITY TYPE:	740
ADDRESS:	322 KEYPORT ST.		TELEPHONE:	(619) 208-7869
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY:	6	CENSUS: 6	DATE:	12/17/2021
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	House Manager, Lauren Delancey		TIME COMPLETED:	10:37 AM

ALLEGATION(S):

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Facility did not control infestation of pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA), Kristina Ryan conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Caregiver, Almina Street and granted entry after identifying herself. LPA met with Lauren Delancey, and explained the purpose of the visit was to deliver findings for the above allegation.

The Department’s investigation consisted of records reviewed, interviews with staff and outside sources and observations.

On January 12, 2021, it was alleged that during unspecified dates in 2020, the facility did not control an infestation of pests, specifically cockroaches. Interviews with initial outside sources had conflicting statements regarding pests; however, no direct evidence or first-hand knowledge was provided, and subsequent interviews with multiple additional outside sources confirmed that they did not observe any cockroaches at the facility while visiting on-site during 2020 to present.
Please see 812-C (Page 1 of 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina Ryan	TELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

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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Control Number 08-AS-20210112081744

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: BLUE SKIES OF OCEANSIDE	FACILITY NUMBER: 374604304
	VISIT DATE: 12/17/2021

NARRATIVE

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Facility staff denied the allegation and stated there was no indication of an infestation of cockroaches during the time period in question. Observations conducted by the Department during the investigation did not support the complaint allegation and noted that the facility interior, including food supply and storage areas, was maintained in clean, sanitary condition on a consistent basis. Facility staff and outside sources confirmed that the facility had monthly pest control services in place, which included a Cockroach Warranty Plan that began September 2020. The same plan was picked up the following month of October 2020 under a new name, with no break in service to date. Records reviewed, including facility records and the pest control contract, corroborated interview statements of staff and outside sources. Pest control records and invoices showed the facility received monthly pest control services, which included a Cockroach Warranty Plan.

The Department has investigated the allegation listed above. Based on evidence obtained, including interviews and records reviewed, the above allegation is unsubstantiated as the Department could not meet the preponderance of the evidence standard.

An exit interview was conducted with Lauren Delancey and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided to the Licensee via email. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of the documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina Ryan	TELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

LIC9099 (FAS) - (06/04)

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