392700993-9-6-2023-27-AS-LKIG-CVSPPF-20230918112928

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 09/06/2023
Date Signed: 09/06/2023 11:07:05 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/01/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230901094747

FACILITY NAME:	A1 DEL MONTE STOCKTON		FACILITY NUMBER:	392700993
ADMINISTRATOR:	SAINI, ANURADHA		FACILITY TYPE:	740
ADDRESS:	517 E. FULTON STREET		TELEPHONE:	(209) 910-5910
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY:	158	CENSUS: 150	DATE:	09/06/2023
		UNANNOUNCED	TIME BEGAN:	10:16 AM
MET WITH:	Lucky Kaur		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility has bed bugs

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9-6-23 at 10:16 am, Licensing Program Analyst (LPAs) Michael Bilger and Arvin Villanueva arrived at facility unannounced to open and continue investigating the complaint allegation noted above. A pre-investigation for this allegation was also conducted on 8-31-23. LPAs met with Assistant Executive Director Lucky Kaur and explained the purpose of the visit. During this investigation, LPAs conducted interviews with three staff and an additional witness. LPAs also conducted a facility observation and reviewed pest control service records as part of this investigation. Based on interviews, it was revealed that a presence of bed bugs existed in room 227 between the period of 8-24-23 and 8-30-23. Interviews, record reviews, and facility observation revealed residents residing in room 227 were moved to an alternative room for safety reasons, and clothing as well as other items were cleaned accordingly; incident was reported by facility to licensing department on 8-30-23. Additionally, interviews and record reviews revealed that bed bug treatment was initiated on 8-30-23 after two pest control companies were notified. Interviews also revealed room 229 was treated as a precaution. {Cont. on 9099C}

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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 3

Control Number 27-AS-20230901094747

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: A1 DEL MONTE STOCKTON	FACILITY NUMBER: 392700993
	VISIT DATE: 09/06/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

A search conducted by LPAs revealed at least 10 pest control companies are in the general vicinity of the facility’s location and not contacted based on interviews conducted and records reviewed.

Based on this investigation, there is a preponderance of evidence to conclude that bed bugs existed within the facility between the period of 8-24-23 and 8-30-23. Additionally, it was determined that the licensee did not ensure a due diligence process of attempting to treat bed bugs in a timely manner. Pest control records reviewed did not indicate a preemptive measure to specifically target bed bug prevention. As a result, this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6. A civil penalty in the amount of $250 is issued in addition to citation due to repeat violation within a 12-month period. An exit interview was conducted with Lucky Kaur and a copy of this report was provided to Lucky. Appeal rights provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20230901094747

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: A1 DEL MONTE STOCKTON	FACILITY NUMBER: 392700993
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 09/20/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee designee has provided pest control service records to LPA indicating completed service.
	8 9 10 11 12 13 14	Based on interviews and record reviews, the facility maintained a presence of bed bugs between 8-24-23 and 8-30-23 with treatment for bed bugs initiated on 8-30-23. This posed a potential health, safety, and resident rights risk to residents in care.	8 9 10 11 12 13 14	Licensee shall provide an updated plan of procedures for processes involving treatment of bed bugs and other pests in the event of reoccurrence. Update shall include evidence of a routine pest control service specifically targeting bed bugs in addition to general service. Plan to be submitted to LPA by POC due date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3