347005009-10-3-2023-27-AS-KHOS-CWJLNA-20231012085401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005009
Report Date: 10/03/2023
Date Signed: 10/03/2023 11:32:03 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, 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
09/21/2023 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20230921081601

FACILITY NAME:	GENE-LYN GUEST HOME, INC.		FACILITY NUMBER:	347005009
ADMINISTRATOR:	GRACE QUIEREZ		FACILITY TYPE:	740
ADDRESS:	7814 NEYLAND WAY		TELEPHONE:	(916) 236-3978
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY:	6	CENSUS: 6	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jennylyn Pulido		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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2
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8
9

Facility staff hit resident

INVESTIGATION FINDINGS:

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2
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5
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9
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Licensing Program Analyst (LPA) Tung Truong arrived at the facility unannounced on 10/3/2023 to conclude the investigation of the above allegation and to deliver the findings. LPA met with facility staff Jennylyn Pulido and explained the purpose of the visit.

Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on information obtained, it was determined that there is not a preponderance of evidence to prove that facility staff hit residents. Based on staff interviews, staff S1 and S2 denied hitting R1 or any residents. Additionally, R1’s mother stated that she believes R1 should be placed in a mental institution. Moreover, it was learned that there were no markings or bruises in the area where R1 stated they were hit.

As a result of the investigation, LPA finds the allegation 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.

An exit interview was conducted, and a copy of the report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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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