392700410-3-13-2024-27-AS-KHOS-D3JL9G-20240320083329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700410
Report Date: 02/23/2024
Date Signed: 03/13/2024 03:24:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/10/2023 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231010133049

FACILITY NAME:	A.J GUEST HOME		FACILITY NUMBER:	392700410
ADMINISTRATOR:	SOARES, CONCEPCION B		FACILITY TYPE:	735
ADDRESS:	1854 ERICKSON CIR		TELEPHONE:	(209) 943-1381
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY:	4	CENSUS: 3	DATE:	02/23/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Concepcion Soares		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff closed the door on resident hand and arm.
Staff refused to let resident back inside the facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst, LPA Kesha Lewis arrived unannounced to deliver findings for the above allegations. LPA spoke with Licensee/Administrator Concepcion Soares regarding the pourpse of the visit.

Allegations: Staff closed the door on resident hand and arm and Staff refused to let resident back inside the facility are UNSUBSTANTIATED.

Althought R1 did have visible brusies on their person interviews with staff and all residents could not comfirm the insident occored therefore, this complaint is UNSUBSTANTIATED. A finding that a 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 did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted. Copy of report given.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

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 1