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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202428
Report Date: 08/27/2025
Date Signed: 08/27/2025 01:25:12 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
07/16/2025 and conducted by Evaluator Kiran Jain
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20250716083606

FACILITY NAME:STONE HAVEN CAREFACILITY NUMBER:
435202428
ADMINISTRATOR:CHIDI IKEMEFACILITY TYPE:
735
ADDRESS:578 N. MATHILDA AVE.TELEPHONE:
(408) 481-9920
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY:33CENSUS: 32DATE:
08/27/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Elizabeth Espique, Lead CaregiverTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff did not ensure the faciltiy was free from pests
INVESTIGATION FINDINGS:
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On 08/27/2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to deliver and discuss the findings of the Complaint allegations and investigation. Upon arrival, the LPA met with the Lead Caregiver, Elizabeth Espique and talked to the Administrator, Chide Ikeme over the phone, and disclosed the purpose of the visit.

On 07/16/2025, the department received a complaint with allegation 'Staff did not ensure the faciltiy was free from pests'.

On 07/23/2025 and 08/20/2025, the department conducted initial investigations at the facility.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 26-AS-20250716083606
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: STONE HAVEN CARE
FACILITY NUMBER: 435202428
VISIT DATE: 08/27/2025
NARRATIVE
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On 07/23/2025 and 08/20/2025, LPA interviewed two (2) staff members together (ADM and S1) and thirteen (13) residents (R1-R13).

ADM stated that they have a monthly bed bug service from HeatRx. The technician comes to inspect bed bugs and treat the bed bug issues they find and are aware of. The housekeeping staff cleans resident rooms. Some residents don’t allow anyone to clean and leave their food in their room. ADM further stated that the facility has had ongoing bed bug issues for the past 5 years or so.

R1 stated that there are no bed bugs in R1’s room. 9 of the 13 residents (R1-R13) interviewed stated that they have either seen bed bugs on their beds and clothes or experienced bed bug bites over the past several months.

On 07/23/2025, during the facility visit, the LPA inspected seven resident rooms and observed clustered dark-colored spots on the mattresses.

On 07/28/2025, LPA obtained and reviewed HeatRx’s monthly bed bug treatment service reports from January 2025 to July 2025. During every visit, live bed bug activity was reported; bed and bed frames in the affected rooms/units were either sprayed or rooms were treated with heat.

On 08/20/2025, the LPA reviewed the facility’s file for past Incident Reports and found that no reports had been submitted regarding bed bug issues at the facility.

Based on observations, interviews conducted, and records reviewed, the Administrator acknowledged that the facility has had ongoing bed bug issues for several years. 9 out of 13 residents interviewed reported seeing bed bugs or experiencing bed bug bites. Clustered dark-colored spots on the mattresses were observed in 7 rooms. In addition, monthly pest control service reports from January 2025 to July 2025 documented live bed bug activities. Despite regular treatment, bed bugs continued to be present in the facility. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

A deficiency is being cited in accordance with the California Code of Regulations, Title 22, see LIC9099-D.

An exit interview was conducted, and the Plan of Correction was reviewed and developed with the Administrator over the phone. A copy of this report and appeal rights were discussed and left with the Lead Caregiver, Elizabeth Espique, whose signature on this form confirms receipt of these documents.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 26-AS-20250716083606
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: STONE HAVEN CARE
FACILITY NUMBER: 435202428
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2025
Section Cited
CCR
80087(a)(1)
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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. (1) The licensee shall take measures to keep the facility free of flies and other insects.
This requirement is not met as evidenced by:
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The Administrator stated that they will submit a written plan detailing the steps and procedures that will be implemented to address and remediate the bed bug infestation moving forward. The plan shall be submitted to the CCL by the POC due date of 09/26/2025.
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Based on observations, interviews conducted, and records reviewed, the facility staff acknowledged that the facility has had ongoing bed bug issues for several years. 9 out of 13 residents interviewed reported seeing bed bugs or experiencing bed bug bites. Clustered dark-colored spots on the mattresses were observed in 7 rooms. Monthly pest control service reports from January 2025 to July 2025 documented live bed bug activities. Despite regular treatment, bed bugs continued to be present in the facility, which poses/posed a potential health, safety or personal rights risk to persons 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: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
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