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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 390318201
Report Date: 12/15/2021
Date Signed: 12/15/2021 10:20:42 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
12/10/2021 and conducted by Evaluator Bruce Jacobs
COMPLAINT CONTROL NUMBER: 27-AS-20211210090213
FACILITY NAME:GIER CARE HOMEFACILITY NUMBER:
390318201
ADMINISTRATOR:GIER, DOMINGAFACILITY TYPE:
735
ADDRESS:9009 CORNWALL DRIVETELEPHONE:
(209) 952-8545
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 4DATE:
12/15/2021
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Dominiga Gier, AdministratorTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Food service is inadequate.

Hygiene items bought for residents irritate the skin of resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Bruce Jacobs conducted an unannounced complaint visit at the facility and met with Facility Manager Maria Dato and Administrator Dominiga Gier LPA conducted interviews with staff, residents, the facility administrator and other witnesses. LPA inspected the home and food supply and completed this complaint investigation and provided findings regarding the allegations listed above.

The complaint allegations listed above was investigated. The residents (C-1,2,3,4), facility staff and management and other witnesses were interviewed by LPA Jacobs. Three residents and all other individuals interviewed denied that the facility's food service is inadequate. Information from one resident on this allegation was inconsistent with other statements obtained.

During LPA's inspection food supply and menus were observed. Care products were observed and also determined to be of adequate quality in in good supply. Based on all interviews and observations, this allegations aredetermined 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 evidence to prove that the alleged violations occurred.
Continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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-20211210090213
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: GIER CARE HOME
FACILITY NUMBER: 390318201
VISIT DATE: 12/15/2021
NARRATIVE
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7
8
9
10
11
12
13
14
15
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17
18
19
20
21
22
23
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25
26
27
28
29
30
31
32
Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are determined to be UNSUBSTANTIATED.

Exit interview conducted, report provided to the Facility Manager.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2