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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 515002008
Report Date: 06/16/2020
Date Signed: 06/19/2020 10:14:20 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2020 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20200312104221
FACILITY NAME:EMERALD OAKSFACILITY NUMBER:
515002008
ADMINISTRATOR:BAKER, BECKYFACILITY TYPE:
740
ADDRESS:2290 FORREST LANETELEPHONE:
(530) 751-0511
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY:99CENSUS: DATE:
06/16/2020
UNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility has bed bugs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emmanuel Ugbah contacted the administrator Becky Baker via phone regarding the allegation that the facility has bedbugs.

Facility has bedbugs - UNSUBSTANTIATED.

By review of documents that were provided by Cal King Pest Control, facility residents R1,R2,R3 have bedbugs in their rooms. This was reported on 02-28-2020 and immediate action was taken by the facility. Facility contacted Cal King Pest control and, according to documents provided by Cal King Pest Control, on 3/03/2020 a complete treatment for bedbugs was completed. Cal King pest control will perform a visual inspection after two weeks to make sure there is no bedbug activity in the facility. The facility has taken all reasonable steps to remedy the incident, therefore the incident is UNSUBSTANTIATED.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020
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 25-AS-20200312104221
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926
FACILITY NAME: EMERALD OAKS
FACILITY NUMBER: 515002008
VISIT DATE: 06/16/2020
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.
An exit interview was conducted. Due to COVID-19 restrictions a copy of the report was emailed to facility administrator Becky Baker. Ms. Baker agrees to sign the report, scan and email it back to LPA by the end of the business day. No deficiencies were cited on today’s date.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020
LIC9099 (FAS) - (06/04)
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