435202473-2-19-2025-26-AS-KHOS-DK2KMK-20250729080140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202473
Report Date: 02/19/2025
Date Signed: 02/19/2025 05:07:00 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
02/11/2025 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20250211111850

FACILITY NAME:	VILA VICTORIA #1		FACILITY NUMBER:	435202473
ADMINISTRATOR:	MR. CYRIL INNEH		FACILITY TYPE:	735
ADDRESS:	393 E. SAN FERNANDO STREET		TELEPHONE:	(408) 271-9244
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	23	CENSUS: 18	DATE:	02/19/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Cyril Inneh		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not address a bedbug infestation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced initial complaint investigation visit and met with Administrator (ADM) Cyril Inneh.

During visit, LPA toured 10 out of 12 resident bedrooms. 2 resident bedrooms were unoccupied during visit.

LPA observed bed bugs in 3 out of the 10 observed resident bedrooms.

LPA interviewed 10 residents during visit. 8 out of 10 interviewed residents stated to have observed bed bugs at the facility. The 8 residents stated to have observed bed bugs between the timespans of today to three months ago. 2 out of the 9 interviewed residents stated to have not seen bed bugs at the facility.

See LIC9099-C for more information. Page 1 of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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 2

Control Number 26-AS-20250211111850

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: VILA VICTORIA #1	FACILITY NUMBER: 435202473
	VISIT DATE: 02/19/2025

NARRATIVE

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6 out of the 9 interviewed residents stated to have observed staff spray for bed bugs inside resident bedrooms. 4 out of the 9 interviewed residents stated to have observed contracted exterminators spray for bed bugs at the facility.

During visit, LPA observed storage rooms of bed bug spray and bed bug traps. LPA observed bed bug traps underneath the feet of each bed in each observed bedroom.

LPA obtained a copy of pest control invoices. One invoice was for bed bug heat treatment that occurred on 06/14/2024. The invoice states that bed bugs were targeted in the bedrooms, box springs, bed frames, and interior. The other two invoices were for contracted sprays that occurred on 11/16/2024 and 01/23/2024. The invoice from 11/16/2024 states that spraying was done within the facility pantry area and the facility exterior for pests. ADM stated that the pest control technician did spray within the facility and sprayed the base boards of the resident bedrooms. However, the invoice only states that the pantry and facility exterior were sprayed. During visit, ADM called the pest control company and confirmed that the next scheduled pest control visit will occur on March 2025. LPA Marrufo was able to hear the pest control company representative confirm the date over speakerphone during the telephone call.

ADM stated staff spray the resident rooms once per month and also wash resident clothing and bedding regularly. Staff S1 stated that S1 cleans resident rooms and launders resident clothing and bedding.

ADM stated that during heating and spray treatments, residents are relocated to the dinning room and also have the option of visiting group activities in nearby community centers.

Based on information from interviews conducted with staff and residents, and records reviewed, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegation is unsubstantiated.

No Deficiencies were cited under California Code of Regulations Title 22.

This report was reviewed with Administrator Cyril Inneh and a copy of this report was provided.
Page 2 of 2. END REPORT.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2