435202288-5-2-2025-26-AS-KHOS-DH2L2P-20250526082241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202288
Report Date: 05/02/2025
Date Signed: 05/02/2025 04:28:25 PM

Unsubstantiated

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
05/01/2025 and conducted by Evaluator Christine Kabariti

COMPLAINT CONTROL NUMBER: 26-AS-20250501100441

FACILITY NAME:	ELIM CARE HOME		FACILITY NUMBER:	435202288
ADMINISTRATOR:	MARK SUNG		FACILITY TYPE:	735
ADDRESS:	15600 LA MAR DRIVE		TELEPHONE:	(408) 771-6275
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	6	CENSUS: 5	DATE:	05/02/2025
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Mark Sung		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Licensee did not ensure facility was adequately treated for pests.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to open the initial complaint investigation. LPA met with Administrator (ADM), Mark Sung.

On 05/01/2025, the Department received a complaint alleging the above allegation. On 05/02/2025, the initial complaint investigation was conducted. The following documents were obtained to include the pest control company contract from the visits.

It was alleged that the licensee did not ensure facility was adequately treated for bed bugs. On 05/02/2025, LPA interviewed the Administrator who stated that this was the first time the Administrator had dealt with bed bugs and admitted that knowing what they know now, they could have done things differently from the day they first observed them. ADM and resident (R1) was unsure where the bed bugs came from.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

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 26-AS-20250501100441

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: ELIM CARE HOME	FACILITY NUMBER: 435202288
	VISIT DATE: 05/02/2025

NARRATIVE

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It was stated that on Wednesday, 04/23/2025 resident (R1) complained of bug bites on his/her arms. Staff checked R1's body and did not observe bug bites other than R1's arm. The ADM fumigated R1's bedroom using an insect eliminator fogger and observed about a couple dead bed bugs after the fumigation. ADM contacted the pest control company for an inspection, in which the pest control company's first availability to inspect the facility was on Friday, 04/25/2025. ADM denied observing any live bed bugs in R1's bedroom. R1 continued to sleep in his/her bedroom that night.

On Thursday 04/24/2025, ADM purchased multiple bed bug foggers and fumigated R1's bedroom while R1 was attending day program. ADM observed about 2-5 dead bed bugs after fumigation. ADM denied observing any live bed bugs in R1's bedroom. R1 continued to sleep in his/her bedroom that night.

On Friday 04/25/2025, ADM fumigated R1's bedroom and observed about 2-5 dead bed bugs after fumigation.

On Friday 04/25/2025, the pest control company also inspected the facility and confirmed the presence of bed bugs in R1's bedroom. The pest control company recommended to do heat treatment for the entire house in case the bed bugs were also inside the walls. ADM states the first availability for a heat treatment was on Thursday 05/01/2025. R1 was moved out of his/her bedroom and was temporarily sleeping on the living room couch awaiting proper treatment to eliminate the bed bugs in R1's room.

Throughout the weekend, the staff were cleaning out R1's bedroom and throwing away a majority of R1's personal belongings per the instruction of R1's authorized representative. The ADM fumigated R1's bedroom using the bed bug foggers until Monday, 04/28/2025. ADM states they also purchased and used this UV light that helps to eliminate insects and bed bugs.

On Tuesday 04/29/2025 - Wednesday 04/30/2025, ADM states they did not fumigate R1's bed room but used diatomaceous earth powder and just sealed R1's room while waiting for their heat treatment on Thursday, 05/01/2025. Page 2 of 3.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20250501100441

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: ELIM CARE HOME	FACILITY NUMBER: 435202288
	VISIT DATE: 05/02/2025

NARRATIVE

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On Thursday 05/01/2025, the pest control company completed heat treatment at the facility. Residents and staff were out of the facility from about 8:00am - 5:00pm. The review of the pest control contract indicates that heat treatment was completed on 05/01/2025.

Based on interview, R1 was not hospitalized due to the bed bug bites. R1's authorized representative was informed and physician was informed who did not advise to take R1 to the hospital. R1 was administered anti-itch cream to treat the bug bites.

No other resident bedrooms and other areas of the facility were affected by the bed bugs. It was stated that the bed bugs were only located in R1's bedroom.

The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Mark Sung and a copy of the report was provided.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

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