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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005009
Report Date: 09/23/2026
Date Signed: 09/23/2026 04:20:08 PM

Document Has Been Signed on 09/23/2026 04:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GENE-LYN GUEST HOME, INC.FACILITY NUMBER:
347005009
ADMINISTRATOR/
DIRECTOR:		GRACE QUIEREZFACILITY TYPE:
740
ADDRESS:7814 NEYLAND WAYTELEPHONE:
(916) 236-3978
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY: 6CENSUS: 6DATE:
09/23/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensee Magie QuierezTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On September 23, 2026, at 1:00 PM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct an annual required inspection. LPA Lopez met with Licensee 1 (A1) Magie Quierez and explained the purpose of today's visit.

The Facility Administrator holds a current certificate #7021127740 and expires on December 12, 2027. The facility is licensed for 6 non-ambulatory residents. There are currently 6 residents who reside at this facility. The facility has an approved hospice waiver for 2. 1 out of the 2 hospice placements are occupied.

At 1:15 PM, LPA conducted record reviews of 6 staff and 6 resident files. Resident files were observed to contain Health Screen Reports and TB test records. The staff files contained the required components and updated training records. At 2:00 PM, LPA conducted a medication review. Resident medications were stored in a locked cabinet. The facility uses a MAR sheet to record all dispensed medication to residents.

At 2:30 PM, the LPA toured the facility with A1. The facility was clean and free of odors. The LPA toured the kitchen and dining room areas. The dining table contained enough seating for the current census. The kitchen contained locked sharps in a kitchen drawer. The facility had a menu posted on the refrigerator door. The LPA observed all cooking equipment was clean and in good working order. The hot water temperature was 103 degrees. The facility temperature was 77 degrees.

The LPA toured the living room area and observed residents watching television. The living room contained activities such as puzzles, bingo, and games for resident use. The facility bathrooms were observed to be clean and sanitary. Continued...
Arielle Pascua
Sulma Lopez
DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GENE-LYN GUEST HOME, INC.
FACILITY NUMBER: 347005009
VISIT DATE: 09/23/2026
NARRATIVE
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The LPA observed that the restrooms contained shared hand towels for all residents to utilize. A1 stated that they provide common towels due to residents' tendency to clog the toilets. Facility showers contained slip-resistant mats and grab bars for resident safety.

LPA toured the resident bedrooms which were clean and free of hazards. The bedrooms contained beds, night stands, closets, and dresser chests in good working condition. The bedrooms contained working smoke detectors on the ceilings. The fire extinguishers were serviced on 9/23/2026.

The facility has equipment for laundry services. The LPA observed a bottle of detergent and softener were unsecured and accessible in the laundry area. Staff 1 (S1) moved the detergent and softener bottles to the secured garage area which was locked and made inaccessible to residents.

The LPA toured the garage which was observed to contain emergency food supply, incontinence briefs, and other storage items.

The exterior of the facility was clean and free of debris. Walkways were observed to be free of obstructions. The side gate and perimeter fence were in good repair.

The LPA requested the following documents to be emailed/ faxed to the Regional Office within 15 days:
- LIC 500 Personnel Report, LIC 308 Designation of Facility Representative, LIC 610E Emergency and Disaster Plan, and a copy of the Liability Insurance Certificate.

As a result of this annual inspection, deficiencies were cited. An exit interview was conducted, and a copy of this report, the LIC 809-D, and Appeal Rights were provided to the facility.
NAME OF LICENSING PROGRAM MANAGER: Arielle Pascua
NAME OF LICENSING PROGRAM ANALYST: Sulma Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 09/23/2026 04:20 PM - It Cannot Be Edited


Created By: Sulma Lopez On 09/23/2026 at 03:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GENE-LYN GUEST HOME, INC.
FACILITY NUMBER: 347005009

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not ensure that the facility hot water was in the range of 105 degrees to 120 degrees, rather it was at 103 degrees which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/23/2026
Plan of Correction
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The Licensee agrees to adjust the water heater temperature and provide a the RO with a copy of the maintenance work order or receipt, and an updated water temperature reading by October 23, 2026 by 5:00PM.
Type B
Section Cited
CCR
87307(a)(3)(C)
Personal Accommodations and Services
(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not ensure that residents did not utilize common towels which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/07/2026
Plan of Correction
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The Licensee agrees to conduct an in-service training with staff on handwahsing procedures and the prohibition of the use of common towels in the facility and will provide a copy of the in-service training roster to the RO by October 7, 2026 by 5:00PM.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Arielle Pascua
NAME OF LICENSING PROGRAM MANAGER:
Sulma Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 09/23/2026 04:20 PM - It Cannot Be Edited


Created By: Sulma Lopez On 09/23/2026 at 03:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GENE-LYN GUEST HOME, INC.
FACILITY NUMBER: 347005009

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interviews, and record reviews, the Licensee did not ensure that detergent and softener bottles were not left unsecured and accessible to residents which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/07/2026
Plan of Correction
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S1 quickly removed the detergent and softener bottles from the unsecured laundry area into the locked garage. The Licensee agrees to conduct an in-service training with staff on proper toxin storage expectations and will send a copy of the training to the RO by 10/07/2026 by 5:00PM.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Arielle Pascua
NAME OF LICENSING PROGRAM MANAGER:
Sulma Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2026


LIC809 (FAS) - (06/04)
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