374604790-2-18-2025-08-AS-SJAB-DEA24G-20250226160351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604790
Report Date: 02/18/2025
Date Signed: 02/18/2025 01:04:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2025 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20250211162354

FACILITY NAME:	BELLAHOMECARE I		FACILITY NUMBER:	374604790
ADMINISTRATOR:	COOK, CHERRY		FACILITY TYPE:	740
ADDRESS:	629 GUAVA AVE		TELEPHONE:	(619) 500-5604
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	6	CENSUS: 5	DATE:	02/18/2025
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Cherry Cook		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility was not kept free of pests
Facility was not kept clean

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegations. LPA identified himself and was granted entry by Caregiver Marcela Torno. LPA stated the purpose of the visit with Caregiver and once again stated the purpose of the visit and reviewed the findings of the complaint with Licensee Cherry Cook who arrived at the facility a short while after.

The Department’s investigation consisted of interviews with staff, residents, review of pertinent records, and LPA observations of the facility grounds, including; resident rooms, bathrooms, common areas, kitchen,garage and outside area.

It was alleged that the facility was not kept free of pests. It was reported that cockroaches were found under a resident's blanket. It was also alleged that the facility was not kept clean. It was reported that trash was not being taken out and the resident rooms and bathrooms were dirty. (Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

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 08-AS-20250211162354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BELLAHOMECARE I	FACILITY NUMBER: 374604790
	VISIT DATE: 02/18/2025

NARRATIVE

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LPA Interviewed Resident 1 (R1) who stated that they have lived at the facility since May 2024 . R1 stated that they have never seen cockroaches in their room or the facility. R1 further stated that they have never seen cockroaches in their bed. R1 stated that R1 as well as several other residents keep food items in their room and the facility staff regularly advises them to "be careful with food in the rooms" since it can attract pests.

LPA interviewed Resident 2 (R2) who stated that they have lived at the facility since May 2024. R2 stated that R2 has never seen any cockroaches in their room, on their bed or in the facility. R2 stated that they have not witnessed trash piled up in the facility or a dirty bathroom.

LPA interviewed Staff 1 (S1) who stated that they have worked at the facility since March 2024. S1 stated that S1 works at the facility three days a week. S1 stated that staff take out the trash every day. S1 stated that most of the resident rooms are cleaned and mopped every other day, with the exception of two resident rooms that are mopped daily due to regular "messes that are made." S1 stated that S1 has never seen any cockroaches in the resident rooms, beds or the facility. S1 stated that a few residents keep food in their rooms and the staff periodically check rooms for spills or trash that needs to be cleaned up.

LPA interviewed Licensee who stated that the facility is cleaned daily including resident rooms and bathrooms. Licensee stated that the facility trash is thrown out every day and the trash "pick up" is weekly. Licensee stated that although the facility has never had any cockroaches, the facility did have a brief issue with "black ants" last year due to food storage in a specific residents room. Licensee stated that the ants were treated and the resident was advised that their food would be stored in the kitchen to avoid ant infestations.

On February 18, 2025, LPA toured the facility. LPA thoroughly inspected each of the resident’s rooms (under blankets, under beds, closets, drawers), bathrooms, dining room, living room, family room, garage, backyard and both sides of the facility. LPA did not find any cockroaches either dead or alive. LPA found all of the trash cans in the facility were emptied out including the trash cans in the kitchen, bathrooms and resident rooms. LPA found all of the resident rooms and bathrooms to be clean with no foul odors. LPA found the facility overall to be clean and sanitary.
(Continued on LIC9099-C)

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20250211162354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BELLAHOMECARE I	FACILITY NUMBER: 374604790
	VISIT DATE: 02/18/2025

NARRATIVE

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Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during interviews, records review, and LPA observations, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated.

The report was discussed, and an exit interview was conducted with Licensee Cherry Cook. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Cherry Cook at the conclusion of the visit. The signature below confirms the receipt of these documents.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

LIC9099 (FAS) - (06/04)

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