500306146-11-8-2023-27-AS-LRIS-CZ4TQT-20240102135627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500306146
Report Date: 11/08/2023
Date Signed: 11/08/2023 01:41:17 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2023 and conducted by Evaluator Renee Campbell

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231101105912

FACILITY NAME:	LAS PALMAS ESTATES		FACILITY NUMBER:	500306146
ADMINISTRATOR:	MILLER, KREGG		FACILITY TYPE:	740
ADDRESS:	1617 COLORADO		TELEPHONE:	(209) 632-8841
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	89	CENSUS: 6	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Kregg Miller, Licensee and Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not keep resident’s room free from bed bugs.

INVESTIGATION FINDINGS:

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On 11/08/23, Licensing Program Analysts (LPAs) Renee Campbell and Ruth Wallace arrived at the facility at approximately 8:45 AM. LPA’s met with Licensee/Administrator Kregg Miller and explained the allegation and the purpose of the visit.

Regarding the allegation that staff did not keep facility free from bed bugs, LPA Campbell interviewed two residents and asked them if they had seen any bed bugs or had been bitten? Resident 1 (R1) and Resident 2 (R2) both stated they had seen bed bugs and had been bitten. LPA’s observed the mattress for R2 and observed a bed bug.

Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

continued on 9099C

Substantiated

Estimated Days of Completion: 7

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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 27-AS-20231101105912

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LAS PALMAS ESTATES	FACILITY NUMBER: 500306146
	VISIT DATE: 11/08/2023

NARRATIVE

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continued from 9099.
Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiency is being cited on the attached 809-D during this visit. If the cited deficiency is not corrected by the noted due date; civil penalties may be assessed. The Facility Designee was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights.
An exit interview was conducted with licensee. A copy of the report and appeal rights were left at facility.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20231101105912

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LAS PALMAS ESTATES	FACILITY NUMBER: 500306146
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/13/2023 Section Cited CCR 87303	1 2 3 4 5 6 7	Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include...policies and procedures for the safety and well-being of residents, employees and visitors. This is evidenced by:	1 2 3 4 5 6 7	Licensee will increase abatement to twice a month, every month and will write a letter to LPA confirming this plan. Licensee will email POC by 11/13/23 to LPA Campbell at renee.campbell@dss.ca.gov.
	8 9 10 11 12 13 14	Based on LPA’s observations and interview, the licensee did not comply with the section cited above in that the bed bugs have not been completely eradicated in the facility. This poses a potential Health, Safety or Personal Rights risk to residents in care.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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