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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701217
Report Date: 07/28/2023
Date Signed: 07/28/2023 03:59:36 PM

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
07/20/2023 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230720122740
FACILITY NAME:EUCLID RESIDENTIAL CAREFACILITY NUMBER:
392701217
ADMINISTRATOR:ASUNCION, TROPYFACILITY TYPE:
735
ADDRESS:2429 W EUCLID AVETELEPHONE:
(209) 915-1713
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:4CENSUS: 4DATE:
07/28/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Tropy AsuncionTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not ensure facility is pest free
INVESTIGATION FINDINGS:
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On 7-28-23 at 10:15am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to open and investigate the complaint allegation noted above. LPAs met with Administrator Tropy Asuncion and explained the purpose of the visit. LPAs requested a copies of evidence of previous pest control services, resident roster, and staffing roster. LPAs also conducted a facility observation and interviews with Administrator and staff1 (S1), S2, and S3. LPAs also interviewed Resident1 (R1) and R2. Additionally, LPAs reviewed photographs submitted by witness (W1) and conducted interviews with W1. Based on interviews and record reviews, it was determined that facility currently has evidence and observance of a prescence of mice including a previous episode of mice in October of 2022 which was unsuccessfully treated by a pest control company. It was further determined that facility staff were aware of a presence of mice increase since October 2022, and was not treated accordingly by another pest control company until July of 2023.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
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-20230720122740
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: EUCLID RESIDENTIAL CARE
FACILITY NUMBER: 392701217
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/31/2023
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds. (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by:
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Licensee shall submit a copy of most recent pest control service outlining procedures of mice prevention. To be submitted to LPA by POC due date.

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Based on observation and interview, Licensee did not maintain a clean, safe, and sanitary living environment in that evidence and observance of a presence of mice were observed and documented. This poses an immediate health and safety risk to residents in care.
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Licensee will read regulation 80087(a) and submit a signed declaration of understanding to LPA by POC due date.

Licensee to submit a plan outlining the assurance of how facility will maintain a clean, safe, and sanitary environment
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20230720122740
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: EUCLID RESIDENTIAL CARE
FACILITY NUMBER: 392701217
VISIT DATE: 07/28/2023
NARRATIVE
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As a result of this investigation, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Citation are issued under Title 22, Division 6 and noted on LIC 9099.

An exit interview was conducted with Tropy Asuncion and a copy of this report was left with Tropy. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3