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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247202977
Report Date: 08/11/2022
Date Signed: 08/11/2022 10:53:28 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, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2022 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20220804150129
FACILITY NAME:C AND D'S GUEST HOME #5FACILITY NUMBER:
247202977
ADMINISTRATOR:DOBBINS, CHANTE L.FACILITY TYPE:
735
ADDRESS:2960 PALOMINO LANETELEPHONE:
(209) 358-8029
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:6CENSUS: 6DATE:
08/11/2022
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Administrator, Sandra BarrosTIME COMPLETED:
11:06 AM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Resident’s hygiene and grooming needs are not being met
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/11/2022, Licensing Program Analyst (LPA) arrived unannounced at the above facility to commence a complaint investigation. LPA introduced self, stated the purpose of the visit and met with Administrator, Sandra Barros.

Based on interviews and observation, the allegation: Resident’s hygiene and grooming needs are not being met is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies issued during this inspection.

An exit interview was conducted with Administrator. A copy of this report was discussed and provided to Administrator Sandra Barros, whose signature on this form confirms receipt of this document.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
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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