392700628-5-9-2022-27-AS-LKIG-CEQSGA-20220524135138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700628
Report Date: 05/09/2022
Date Signed: 05/09/2022 03:50:46 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-20220321110555

FACILITY NAME:	G.L.O.M. A.R.F. 5		FACILITY NUMBER:	392700628
ADMINISTRATOR:	JESSICA OWENS		FACILITY TYPE:	772
ADDRESS:	458 ALMOND DRIVE		TELEPHONE:	(925) 570-3282
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	16	CENSUS: 14	DATE:	05/09/2022
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Jessica Owens, Administrator		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is in financial distress

INVESTIGATION FINDINGS:

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

On 05/09/2022 at 2:35pm, Licensing Program Analyst (LPA) T. White arrived unannounced to open and investigate the complaint allegation noted above. LPA 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.

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 on previous complaint #27-AS-20211201131243.
An exit interview conducted with Administrator. A copy of report and Appeal rights given.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

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

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-20220321110555

FACILITY NAME:	G.L.O.M. A.R.F. 5		FACILITY NUMBER:	392700628
ADMINISTRATOR:	JESSICA OWENS		FACILITY TYPE:	772
ADDRESS:	458 ALMOND DRIVE		TELEPHONE:	(925) 570-3282
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	16	CENSUS: 14	DATE:	05/09/2022
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Jessica Owens, Administrator		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Excluded individual is present at the facility

INVESTIGATION FINDINGS:

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

On 05/09/2022 at 2:35pm, Licensing Program Analyst (LPA) T. White arrived unannounced to open and investigate the complaint allegation noted above. LPA met with Administrator, Jessica Owens and explained the purpose of the visit.

During course of investigation, LPA interviewed 4 clients and 3 staff members. 3 of 4 stated they do not know the excluded individual. 1 of 4 clients and 3 of 3 staff members have not seen excluded individual at the facility. Staff #1 (S1) and Client #1 (C1) stated the excluded individual has not been present at the facility. However, S1 and C1 stated the excluded individual attended facility Easter event on 04/17/2022.

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: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

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 2