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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881358
Report Date: 04/12/2025
Date Signed: 04/12/2025 02:03:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2024 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20241113130413
FACILITY NAME:SUN CITY GARDENSFACILITY NUMBER:
331881358
ADMINISTRATOR:DIANE DOMINGOFACILITY TYPE:
740
ADDRESS:28500 BRADLEY ROADTELEPHONE:
(951) 679-2391
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:74CENSUS: 43DATE:
04/12/2025
UNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Barbara Guzman, Buisness ManagerTIME COMPLETED:
02:06 PM
ALLEGATION(S):
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Facility staff failed to keep facility free of pests (nats, bed bugs, maggots).
INVESTIGATION FINDINGS:
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Licensing Program Analsyt (LPA) Alberto Lopez made an unannounced visit to investigate the above allegation. LPA met with Business Manager Barbara Guzman and discussed the purpose of the visit.

The investigation consisted of obtaining and reviewing staff and resident rosters, interviewing six (6) staff and eight (8) residents, taking a tour of resident rooms and common areas, Invoice from Orkin Pest control dated 03/26/2025. LPA also obtained and reviewed Orkin Service Reports dated 10/28/2024, 11/01/2024, 11/06/2024, 11/14/2024, 12/04/2024, 12/06/2024, 12/18/2024, 01/17/2025, 01/22/2025, 01/24/2025, 01/29/2025, 02/6/2025, 02/06/2025.

The investigation revealed. Allegation: Facility staff failed to keep facility free of pests (nats, bed bugs, maggots). It is alleged that there is an infestation of bedbugs, maggots and nats in some rooms at facility and that facility failed to keep rooms free of pest. (continued on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2025
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 3
Control Number 18-AS-20241113130413
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUN CITY GARDENS
FACILITY NUMBER: 331881358
VISIT DATE: 04/12/2025
NARRATIVE
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(continued from 9099)

LPA interviewed six (6) staff and four (4) of six (6) staff stated they were aware of the pest issue and those staff stated that the facility has addressed the pest issue since. LPA interviewed eight (8) residents and five (5) of eight (8) residents were able to corroborate the allegations. LPA took tour of common areas in building 100, 200, and 300 and rooms 251, 252, 253, 255, 270, 275, 278, 134, 119 and 381. During the tour of the rooms, LPA observed and took pictures of dead bed bugs or insects in the base boards in the closets of room 251 and room 275. LPA did not observed any living bedbugs, insects, mice or other pests in any other rooms or areas inspected by LPA The facility has ongoing contract with Orkin Pest control and LPA reviewed and obtained copies of service reports dated 10/28/2024 (treatment of bed bugs room 251), 11/01/2024 (treatment of bedbugs room 251),11/06/2024 (inspection of room 251 (treatment for mice upstairs building 200 and 300), 11/14/2024 (treatment for mice, rooms 251, 275 for bedbugs), 12/04/2024 (inspection for bed bugs, rooms 251, 272), 12/18/2024 (treatment for bedbugs, rooms 251, 252, 255) 01/17/2025 (treated room 251 for bed bugs-found no living ones), 1/29/2025 (Inspection only), 01/22/2025 (follow-up treatment for bed bugs, rooms 251,253, 255, 314,316, 381, 385, 387, 389, 388, 378, 339, 333, 328, 312, 310, 308), 01/24/2025 (inspection, removal of trapped mice and recommendations) 02/06/2024 (K9 inspection of rooms 251, 252, 253, 254. Live activity found in units 252, 253, 254), 02/28/2025 (first day of heat treatment for bed bugs and termites for rooms 251, 252, 253, 255, 254, 256 and the lower 6 units under those on second day of treatment), 03/26/2025 (invoice for termite heat). The treatment is ongoing and facility will be required to provide proof that the all the pest have been eradicated from the entire facility. There is sufficient evidence to support the allegation.

Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 12, Chapter 1), are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report was provided to Business Manager Barbara Guzman.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20241113130413
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SUN CITY GARDENS
FACILITY NUMBER: 331881358
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2025
Section Cited
CCR
87303(a)
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Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by
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Facility must provide proof from Orkin pest control that facility has eradicated all pest including but not limited to bed bugs, nats, maggots. Proof of correction can be sent to LPA by POC date of 04/26/2025
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LPA observed room 251 had dead bedbugs inside the closet by the baseboards and room 275 had evidence of dead insects behind the drawer and by the closet doors. Some residents corroborated the allegation and staff stated they have been addressing the pest issue which poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3