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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700997
Report Date: 04/14/2022
Date Signed: 04/15/2022 11:16:06 AM

Unsubstantiated


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
02/22/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220222163759
FACILITY NAME:CAMLU ASSISTED LIVINGFACILITY NUMBER:
392700997
ADMINISTRATOR:WHITTED, ALMAFACILITY TYPE:
740
ADDRESS:6037 N. PERSHING AVENUETELEPHONE:
(209) 951-2030
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:160CENSUS: DATE:
04/14/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
11:00 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 4/15/22 at 9:30am Licensing Program Analysts (LPAs) Maja Jensen and Michael Bilger arrived at the facility unannounced to deliver complaint investigation findings related to the above allegation. LPAs met with Resident Care Coordinator Andrea Eldridge and explained the purpose for today's visit.

LPA Maja Jensen interviewed staff 1 (S1) on 3/30/33, staff 2 (S2) on 2/25/22, staff 3 (S3) on 2/25/22 and resident 1 (R1) on 2/25/22. LPA Jensen toured multiple resident rooms on 2/25/22. On 4/14/22 LPA Jensen reviewed a monthly service contract with a pest control service dated 2/22/22 and service receipts for November 2021 and December 2021. LPAs Jensen and Bilger observed on 3/30/22 that the facility has conducted renovations that include replacing all carpeting with laminate flooring and the facility has purchased new furniture to replace all existing furniture. On 4/15/22 the Resident Care Coordinator advised that the facility is currently clear of bed bugs. This allegation is UNSUBSTANTIATED. Based on the observations, interviews and records reviewed, the facility is taking all actions necessary to control and eradicate pest infestation.
An exit interview was conducted and a copy of this report was left with the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
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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