Complaint·November 18, 2025

(CONTINUED FROM PAGE 1, LIC 9099) A Department interview with an Outside Source (OS) revealed that a visit to the facility was conducted the week of November 9 to 15, 2025 and the OS also observed cockroaches in the same location- on the kitchen countertop next to the stove. Interviews with (3) residents revealed that residents have not witnessed cockroaches in any communal areas, bedrooms or bathrooms, but have observed them in the kitchen. An interview with Care Staff #1 (CS1) revealed that the problem started about a month ago in a small section of the kitchen near the stove, and CS1 placed traps behind the refrigerator and stove. An interview with Resident #1 (R1) corroborated that R1 witnessed traps in the kitchen. Staff also placed traps on the counters near the kitchen appliances. Interviews with CS1, the Licensee and R1 revealed that the facility was fumigated approximately one year ago and all residents had to relocate. Based on the evidence obtained from observations and interviews, the complaint allegation is substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is cited per Title 22 California Code of Regulation. LPA Silveira conducted an exit interview with Sherell, to whom a copy of this report, the LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. Signature below confirms receipt of the reports.