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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700627
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:39:49 PM

Substantiated


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
03/21/2022 and conducted by Evaluator Treana White
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220321111505
FACILITY NAME:G.L.O.M. A.R.F. 4FACILITY NUMBER:
392700627
ADMINISTRATOR:JESSICA OWENSFACILITY TYPE:
772
ADDRESS:8210 BRIGHT STREETTELEPHONE:
(209) 330-7155
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95231
CAPACITY:15CENSUS: 15DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jessica Owens, AdministratorTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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9
Facility is in financial distress
INVESTIGATION FINDINGS:
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On 05/12/2022 at 2:30pm, Licensing Program Analysts (LPAs) T. White and R. Campbell arrived unannounced to open and investigate the complaint allegation noted above. LPAs met with Administrator, Jessica Owens and explained the purpose of the visit.

During the course of the investigation on 03/02/2022, the Department conducted a solvency audit and conducted interviews. The audit conducted by the department found that the licensee does not generate sufficient income to meet its current financial obligations; the licensee does not maintain sufficient cash reserves to ensure provisions of care and supervision to clients; the licensee did not pay leases timely and the licensee incurred a Federal tax lien totaling $260,000.

Report continues on 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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 3
Control Number 27-AS-20220321111505
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: G.L.O.M. A.R.F. 4
FACILITY NUMBER: 392700627
VISIT DATE: 05/12/2022
NARRATIVE
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Based on information provided through documentation and interviews, the allegation that the facility is in financial distress is SUBSTANTIATED. A substantiated finding means that there is a preponderance of evidence to prove that the allegation occurred as alleged.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies were cited on previous complaint # 27-AS-20211201131514.

An exit interview conducted with Administrator. A copy of report and Appeal rights given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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
03/21/2022 and conducted by Evaluator Treana White
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220321111505

FACILITY NAME:G.L.O.M. A.R.F. 4FACILITY NUMBER:
392700627
ADMINISTRATOR:JESSICA OWENSFACILITY TYPE:
772
ADDRESS:8210 BRIGHT STREETTELEPHONE:
(209) 330-7155
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95231
CAPACITY:15CENSUS: 14DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jessica Owens, AdministratorTIME COMPLETED:
03:55 PM
ALLEGATION(S):
1
2
3
4
5
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9
Excluded individual is present at the facility
INVESTIGATION FINDINGS:
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On 05/12/2022 at 2:35pm, Licensing Program Analysts (LPAs) T. White and R. Campbell arrived unannounced to open and investigate the complaint allegation noted above. LPAs met with Administrator, Jessica Owens and explained the purpose of the visit.

During course of investigation, LPAs interviewed 4 clients and 2 staff members. 3 of 4 clients and 2 of 2 staff members stated they have not seen excluded individual at the facility. However, Client #2 (C2) stated on 04/17/2022, the excluded individual attended facility Easter event at the park.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator and a copy of report given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3