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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 11/21/2024
Date Signed: 11/21/2024 04:18:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2024 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20241115123254
FACILITY NAME:CHATEAU LONG BEACHFACILITY NUMBER:
197800131
ADMINISTRATOR:CINDY NICOLSONBOLONGFACILITY TYPE:
740
ADDRESS:3100 E. ARTESIA BLVD.TELEPHONE:
(562) 428-5371
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:184CENSUS: 90DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:Administrator Cindy A. Nicolson-BolongTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Licensee is not addressing pests at facility.
INVESTIGATION FINDINGS:
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On 11/21/24 Licensing program analyst (LPA) Villegas conducted an initial complaint visit regarding the allegations above. LPA met with Administrator (A1) Cindy A. Nicolson-Bolong as the purpose of today’s visit was explained.

The investigation consisted of the following: On 11/21/24 between 9:00am-11:30am LPA conducted interviews with residents #1-9 (R1-R9), and between 11:30am-12:20pm LPA conducted interviews with staff #1-4 (S1-S4). On 11/21/24 at 12:20pm LPA attempted to reach W1 for an interview, at 12:30pm LPA onducted interview with A1. On 11/21/24 LPA obtained copies of the following: Staff and resident rosters, invoice from Orkin dated 11/15/24, service report from Orkin dated 10/24/24 and 11/15/24, and housekeeping logs from January 2024-November 2024. On 11/21/24 LPA obtain copies of documents pertinent to the complaint for R1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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 11-AS-20241115123254
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CHATEAU LONG BEACH
FACILITY NUMBER: 197800131
VISIT DATE: 11/21/2024
NARRATIVE
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The investigation revealed the following:
Allegation: Licensee is not addressing pests at facility.

It is being alleged that the facility is infested with rats that crawl on the residents during the nigh, and the license hasn't hired a pest control company to address the matter. On 11/21/24 between 9:00am-11:30am LPA conducted interviews with R1-R9 regarding the allegation above 8 of 9 residents denied the allegation above. 1 of 9 residents interviewed confirmed the allegation above and reported feeling "critters" crawling on resident at night. On 11/21/24 between 11:30am-12:20pm LPA conducted interviews with S1-S4 regarding the allegation above, 4 of 4 staff interviewed denied the allegation above and reported rats have not been observed at the facility. On 11/21/24 LPA called W1 regarding the allegation above, however no contact was made. On 11/21/24 LPA conducted a review of housekeeping logs, invoice from Orkin pest control dated 11/15/24, service report from Orkin pest control dated 10/24/24 and 11/15/24. LPA observed documentation detailing there are exterior bait stations placed around the building perimeter for rodent control. LPA toured the inside and outside of the facility and there were no health or safety concerns observed. On 11/21/24 at 12:30pm LPA conducted interview with A1 regarding the allegation above and reported the facility has a contract with Orkin pest control who comes out once a month or when needed.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted with Administrator Cindy A. Nicolson-Bolong, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2