565801764-9-12-2024-29-AS-KHEN-D9FTX5-20240925150634

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801764
Report Date: 09/12/2024
Date Signed: 09/12/2024 11:22:38 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2024 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240911145548

FACILITY NAME:	HAPPY HOME CARE II		FACILITY NUMBER:	565801764
ADMINISTRATOR:	MICHAEL ROSALES		FACILITY TYPE:	740
ADDRESS:	1273 SHEFFIELD PLACE		TELEPHONE:	(805) 371-7801
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 3	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	Karina Antig		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Resident room has ant infestation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced initial complaint visit to this facility. LPA initially met with facility staff and explained the reason for the visit. At 09:58AM, Assistant Administrator Karina Antig arrived at the facility. Entrance interview conducted.

Starting at 09:55AM, the LPA conducted interviews with 2 (two) staff, the Assistant Administrator, and 3 (three) residents. At 10:39AM, the LPA along with the Assistant Administrator conducted a physical plant tour. The following was then determined:

It was alleged that resident room has an ant infestation, as ants were observed on the wall, on the bed and in Resident #1 (R1)'s linens. 2 (two) residents interviewed (including R1) indicated they have seen no ants. R1 indicated that facility staff take good care of them and that R1 would notify staff if they observed any unwanted pests. 1 (one) other resident interviewed did indicate they had seen just a few ants a couple
Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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 29-AS-20240911145548

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HAPPY HOME CARE II	FACILITY NUMBER: 565801764
	VISIT DATE: 09/12/2024

NARRATIVE

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days ago and that staff had responded quickly to spray the ants and clean up the area. No ants have been observed since then. Staff interview revealed that last week during the heat wave, some ants had been observed in R1's room, but that staff had sprayed outside the home and did clean up the ants inside the resident's room. Staff stated there has not been a problem since then. During today's facility tour, LPA did not observe any ants in the facility, nor any evidence of any a prior infestation. All interviews indicated there were few ants in the facility and staff responded quickly and appropriately to maintain the facility in clean, safe condition. Based on observation and interview, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore the allegation "resident room has ant infestation" is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted with Assistant Administrator. A copy of today's report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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