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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700628
Report Date: 03/02/2022
Date Signed: 03/02/2022 02:40:57 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
12/01/2021 and conducted by Evaluator Liza King
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20211201131657
FACILITY NAME:G.L.O.M. A.R.F. 5FACILITY NUMBER:
392700628
ADMINISTRATOR:JESSICA OWENSFACILITY TYPE:
772
ADDRESS:458 ALMOND DRIVETELEPHONE:
(925) 570-3282
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:16CENSUS: DATE:
03/02/2022
ANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:LIsa EvansTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Financial Issues
INVESTIGATION FINDINGS:
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Licensing Program Manager (LPM) Liza King met with Licensee Representative Lisa Evans via Microsoft Teams to deliver complaint findings regarding the allegations noted.

The initial 10-day visit was conducted on 12/6/2021. During the course of the investigation, 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. Based on information provided through documentation and interviews, the allegation that the facility is having financial issues 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.
An exit interview was conducted with representative Linda Evans via telephone and a copy of this report along with appeal right was provided via email and an electronic email read receipt confirms receiving these documents.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Krystall Moore
LICENSING EVALUATOR NAME: Liza King
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
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 2
Control Number 27-AS-20211201131657
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. 5
FACILITY NUMBER: 392700628
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2022
Section Cited
CCR
80062(a)
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80062(a)(1) Finances. The licensee shall meet the following financial requirements: (1) Development and maintenance of a financial plan which ensures resources necessary meet operating costs for care and supervision of clients.

This regulation was not met as evidence by:
The Licensee did not ensure the development and maintenance of a financial plan which ensures resources to meet operating costs. Based on documentation, the Licensee is not paying leases timely and is relying heavily on loans to cover expenditures. This poses a potential risk to residents in care.
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The licensee agrees to:
The licenssee agrees to:
• Provide proof of payment of the $260,000 federal tax liens by 03/30/2022
Type B
03/31/2022
Section Cited
CCR
80063(a)
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80063(a) Accountability. (a) The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation.
This regulation was not met as evidence by:
The Licensee did not maintain general supervision of the facility and did not establish policies to ensure financial stability. Based on audit findings, the licensee secured lines of credit based on potential profits that were not secured, causing insolvency . This poses a potential risk to residents in care.
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The licensee agrees to
• Provide an annual budget showing all anticipated income and expenditures for the organization as a whole, projected for 12 months beginning April 1, 2022 through March 31, 2023
• By the 3rd week following each quarter of the period, beginning April 1, 2022 through March 31, 2023, provide to Audits Section an income statement for the 3rd month of the quarter. Example income statement for June 2022 would be provided to Audits by 3rd week of July 2022.
• Source documents used to prepare the income statement must be provided. Auditor must be able to trace and confirm reported revenues and expenditures to source documents provided.
• Quarterly financial reporting is to continue for a period of 1 year, or until it is evident that the licensee has a financial plan that satisfies CCR Section 80062.
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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.
SUPERVISORS NAME: Krystall Moore
LICENSING EVALUATOR NAME: Liza King
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC9099 (FAS) - (06/04)
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