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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700627
Report Date: 12/19/2024
Date Signed: 04/07/2025 03:28:01 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
12/11/2024 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20241211103115
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:
12/19/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Jessica OwensTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not prevent an inappropriate sexual interaction between clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Administrator Jessica Owens. and explained the reason for the visit. Census: 15
Staff did not prevent an inappropriate sexual interaction between clients - LPA Lund reviewed facility records, interviewed staff, and clients in care. Based on facility records reviewed, interviews with staff, and clients in care. LPA Lund reviewed Unusual Incident/Injury Report (LIC624) dated 11/18/2024 and reported to CCL on 11/18/2024. Client (C1) reported to Administrator Jessica Owens that Client (C2) inappropriately violated the boundaries of C1. C1 stated that it only happened one time and has not happened again. C1 refused to press charges against C2.
On 4/7/2025- LPA Jason Lund arrived unannounced to amended a complaint.

Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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 2
Control Number 27-AS-20241211103115
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: G.L.O.M. A.R.F. 4
FACILITY NUMBER: 392700627
VISIT DATE: 12/19/2024
NARRATIVE
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Staff have had mandatory training from San Joaquin Behavior Health Services, in that training it goes over mandating reporting. Staff interviewed stated that when the here are see something they report it to management. Clients interviewed stated that they would report any usual incidents to staff. Clients also sated that they feel safe at the facility.

Based on facility records reviewed, interviews with staff, and clients in care, on the information provided, it was unclear if staff did not prevent an inappropriate sexual interaction between clients , therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of 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. Exit interview conducted and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2