415600808-9-5-2023-14-AS-KHOS-CVKH35-20230911054946

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600808
Report Date: 09/05/2023
Date Signed: 09/05/2023 11:16:11 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/30/2023 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230830150459

FACILITY NAME:	ALWAYS TLC		FACILITY NUMBER:	415600808
ADMINISTRATOR:	CONSUNJI, TOMAS		FACILITY TYPE:	740
ADDRESS:	226 SANDPIPER COURT		TELEPHONE:	(650) 345-1441
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY:	6	CENSUS: 6	DATE:	09/05/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Caregiver, Doris Mores		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff do not ensure facility is free from roaches.

INVESTIGATION FINDINGS:

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On September 5, 2023, Licensing Program Analyst (LPA) Murial conducted an unannounced 10-day complaint visit. LPA was greeted by caregiver, Doris Mores who contacted the administrator via phone and reported LPA's visit. LPA explained the purpose of today's visit to caregiver and administrator who was on the phone.

Regarding to allegation of- staff do not ensure facility is free from roaches, the reporting party reported that about a couple of weeks ago, facility was spotted of having cockroaches in the kitchen and in resident's rooms. The reporting party also reported that the administrator is working with a pest control service to resolve the problem as soon as possible.

LPA toured the facility with caregiver and the facility observed to be cleaned, and tidy; LPA did not observed any cockroaches.

LPA interviewed the administrator who acknowledged that facility discovered cockroaches a couple of months ago and facility has been working with a pest control company to resolve the problem. In addition, the administrator stated that the pest control company came out on July 27, 2023 and provided treatment and they are scheduled to come back today (September 5, 2023) to do another treatment.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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 14-AS-20230830150459

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALWAYS TLC	FACILITY NUMBER: 415600808
	VISIT DATE: 09/05/2023

NARRATIVE

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LPA interviewed staff #1 (S1) who stated that they are aware of the cockroach problem in the facility and the administrator is working with a pest control company to resolve it.

LPA interviewed resident #1 (R1) and R1's responsible party who stated that staff does a good job with ensuring the facility is cleaned and tidy and they are aware of cockroaches at the facility and the administrator is actively working with a pest control company to take care of this issue. In addition, R1 stated that the room is always cleaned and staff mops the floor twice daily.

Based on documents provided, LPA observed a service slip from a pest control company showing the service was provided on July 27, 2023, and on August 18, 2023, administrator reported to the pest control company that R1 spotted roaches in R1's room which triggered a service scheduled for today (September 5, 2023) and monthly thereafter.

Based on observation, interviews and record review, this allegation is unsubstantiated as the facility discovered the problem prior to this complaint and the administrator has been working with a pest control company to resolve the problem.

Although the above investigations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

This report is discussed with the administrator who arrived during the exit meeting.

A copy is provided.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC9099 (FAS) - (06/04)

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