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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201046
Report Date: 11/03/2025
Date Signed: 11/03/2025 12:28:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/31/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20251031090633
FACILITY NAME:LASSENPARK RESIDENTIAL HALL(RH)FACILITY NUMBER:
435201046
ADMINISTRATOR:VALIN, AMOR & VIRGILFACILITY TYPE:
735
ADDRESS:364 LASSENPARK CIRCLETELEPHONE:
(408) 227-1129
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:6CENSUS: 6DATE:
11/03/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensee Virgil Valin
Staff Jenny Baliga		TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff are not addressing issue with bedbugs in the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin arrived unannouced to conduct an initial complaint investigation visit. LPA met with Staff Jenny Baliga. LPA stated the purpose of the visit. S1 called Licensee Virgil Valin. Licensee stated he would arrive at the facility as soon as possible. Licensee arrived at the facility at 11AM.

On 10/31/2025 the Department received a complaint alleging that staff are not addressing an issue with bedbugs in the facility.

On 10/31/2025 LPA Tarin interviewed Witness 1 (W1). W1 states he/she observed R1 with bedbugs bites on his/her stomach and back area on 10/23/2025.

Page 1 of 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
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 26-AS-20251031090633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: LASSENPARK RESIDENTIAL HALL(RH)
FACILITY NUMBER: 435201046
VISIT DATE: 11/03/2025
NARRATIVE
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On 11/3/2025 LPA Tarin interviewed Licensee. Licensee states he has been aware for the past two weeks that the facility has bedbugs. Licensee stated he has observed bedbugs in the cracks between the floorboards and walls of resident rooms. Licensee states he has observed R1 with bedbugs bites on his/her body approximately 2 weeks ago. Licensee states he has purchased bedbug spray, and has staff spraying the residents rooms for bedbugs. Licensee also states staff are placing resident's mattresses outside in the sun once a week to get rid of the bedbugs.

LPA interviewed 6 Residents (R1 to R6). 3 Out of 6 Residents (R1, R2, and R5) states he/she has seen bedbugs in his/her room. R1 and R5 states he/she has been bitten by bedbugs, but doesn't remember the date. R5 showed LPA his/her left leg, and LPA observed red circular areas. R1 showed LPA his/her arms, and LPA observed red circular areas on both arms. R3, R4, and R6 did not provide additional information regarding bedbugs.

LPA interviewed 2 Staff (S1 to S2). S1 states he/she has been spraying the resident rooms for bedbugs, but doesn't recall when he/she started spraying. S2 states he/she does not spray resident rooms for bedbugs. S2 did not provide additional information.

LPA inspected 6 resident's mattresses with S1. During inspection, LPA observed 6 Out of 6 Resident mattress covers to have dark colored spots/areas, and dark colored streaks on all 4 sides, tops and bottom of mattress covers. LPA observed 2 bedbugs crawling on a mattress in Bedroom #1. LPA observed a dead bedbug underneath a bed in Bedroom #2.

Based on LPA's observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A deficiency is being cited, per California Code of Regulations, Title 22, see LIC 9099D.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20251031090633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: LASSENPARK RESIDENTIAL HALL(RH)
FACILITY NUMBER: 435201046
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2025
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 was not met as evidenced by:
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Licensee stated they will submit a written plan of action on how they will ensure resident's bedrooms are free from bedbugs. Licensee will seek professional help to address the issue. Licensee stated they will submit the written plan of action to the Department by POC due date 11/4/2025.
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Based on observation and interview the licensee did not ensure 6 resident's bedding and mattresses were free from bedbugs, which poses an immediate health, safety and personal rights risk to 6 residents in care.
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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: Brenda Chan
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
LIC9099 (FAS) - (06/04)
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