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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347003931
Report Date: 04/06/2022
Date Signed: 04/06/2022 03:49:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/10/2022 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20220310111928
FACILITY NAME:BILBY HOME INC.FACILITY NUMBER:
347003931
ADMINISTRATOR:JAIME GACILANFACILITY TYPE:
735
ADDRESS:5411 MARIOLYN WAYTELEPHONE:
(916) 670-6015
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 6DATE:
04/06/2022
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Natalie Gacilan, House ManagerTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
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3
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9
Resident sustained injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
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5
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9
10
11
12
13
Licensing Program Analyst (LPA) Tung Truong arrived at the facility unannounced on 04/06/2022 at 2:40 pm to conclude the investigation of the above allegation and to deliver the findings. LPA met with House Manager, Natalie Gacilan, and explained the purpose of the visit. LPA spoke with Administrator Jaime Gacilan on the phone and was advised that House Manaager can sign the report.

Throughout the course of the investigation, LPA Truong conducted interviews and reviewed facility documents. Based on LPA’s observation on the initial visit on 3/10/2022, Client C1 did not have any visible injuries or sign of abuse. Based on interviews, it was learned that Client (C3) tries to attack C1 due to C1 being loud; however, facility staff already got to C3 and redirect C3 to his room. As a result, there was no physical contact between C3 and C1.

Report continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
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 2
Control Number 27-AS-20220310111928
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: BILBY HOME INC.
FACILITY NUMBER: 347003931
VISIT DATE: 04/06/2022
NARRATIVE
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As a result of this investigation, the Department finds the allegations above to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2