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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425398
Report Date: 09/23/2021
Date Signed: 09/23/2021 11:40:36 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, 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
09/16/2021 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210916153334
FACILITY NAME:ANNA'S PARK HAVENFACILITY NUMBER:
336425398
ADMINISTRATOR:ANNA ESTANIELFACILITY TYPE:
740
ADDRESS:3911 PARK AVENUETELEPHONE:
(951) 658-6223
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:6CENSUS: 6DATE:
09/23/2021
UNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Administrator Anna EstanielTIME COMPLETED:
11:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has bed bugs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced visit to the facility to investigate the above allegation. LPA met with administrator Anna Estaniel.

The investigation consisted of file review and interviews with relevant parties. The allegation indicates that the facility has bed bugs. LPA conducted a tour of the facility to include an inspection of resident bedrooms. During the visit, LPA did not notice any findings of the presence of bed bugs in the facility. Additionally, the facility staff has contracted with a pest control agency for the past 5 years and who provide exterminator services every 2 months. LPA witnessed the exterminator schedule and verified the visits.

LPA interviewed a female resident (R1) as well as a male resident (R2) who stated that there were no issues with bed bugs. LPA attempted to interview the remaining female residents (R3)(R4), but was not successful due to their medical condition. LPA did not observe any visible rash on any of the residents that could have contributed to being bug bites per the complaint. LPA was also informed by facility staff that staff are trained to check the residents rooms and report any bed bug sightings. This concluded the visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Reyna Lacey
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
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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