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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700186
Report Date: 09/06/2024
Date Signed: 09/06/2024 03:00:56 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2024 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20240415090932
FACILITY NAME:WALNUT HOUSEFACILITY NUMBER:
342700186
ADMINISTRATOR:VICKY CROSSFACILITY TYPE:
740
ADDRESS:3401 WALNUT AVETELEPHONE:
(916) 483-6612
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:110CENSUS: 65DATE:
09/06/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Allison LopezTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff are not ensuring that facility is free of pests
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the finding of the allegation cited above. LPA met with Administrator, Allison Lopez, and explained the purpose of the visit.

During the course of this investigation, LPA conducted file review and interviews.

The result of the investigation is as follow in LIC 9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
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 3
Control Number 59-AS-20240415090932
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WALNUT HOUSE
FACILITY NUMBER: 342700186
VISIT DATE: 09/06/2024
NARRATIVE
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LIC 9099-C

Allegation: Staff are not ensuring that facility is free of pests
The Department conducted interviews and file review. Based on interview with former Administrator on 10/27/2023, it revealed that facility does not have a cockroach and/or bedbug infestation but there has been a few occasion of bedbug detection in residents room. Interview revealed that it is unclear where and/or how bedbugs are entering the facility but Licensee is taking active actions wherever pest is detected by caregivers. Based on interview conducted with current Administrator conducted on 9/6/2024, it revealed facility had a recent bedbug treatment was conducted on 8/21/2024 for Room 47, Room 66 to Room 76 and no evidence of active bedbug was detected. Interview revealed that pest control treatments at the facility has been ongoing as needed. Interview further revealed that facility has been in contact with Aantex Pest Control for treatments for bedbugs the moment it is detected and additionally facility is being serviced for monthly pest control. File review revealed there are invoices from Aantex Pest Control for monthly service and/or bedbug treatments on 1/17/2024, 1/29/2024, 2/21/2024, 2/22/2024, 2/23/2024, 3/1/2024, 3/7/2024. Additionally, file review further revealed there are invoices from Clark Pest Control from 3/18/2024 and 6/19/2024 for bedbug treatments.

Based on information obtained through file review and interview, the allegation listed above are UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of the report was left with Administrator.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC9099 (FAS) - (06/04)
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