392700628-4-11-2023-27-AS-CACL-CTXT89-20230721142954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700628
Report Date: 04/11/2023
Date Signed: 04/11/2023 01:32:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
04/10/2023 and conducted by Evaluator Renee Campbell

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230410145838

FACILITY NAME:	G.L.O.M. A.R.F. 5		FACILITY NUMBER:	392700628
ADMINISTRATOR:	JESSICA OWENS		FACILITY TYPE:	772
ADDRESS:	458 ALMOND DRIVE		TELEPHONE:	(209) 330-7155
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	16	CENSUS: 15	DATE:	04/11/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Jessica Owens, Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility does not provide adequate food service.
Facility in disrepair.

INVESTIGATION FINDINGS:

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On 04/11/2023 at 12:00 pm, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to investigate and deliver complaint findings for the allegations noted above. LPA met with Jessica Owens, Administrator and later Lisa Evans, Program Manager and explained the purpose of the visit.

Based on LPA's observation and interviews, LPA found no evidence of disrepair. Tiles and toilets were not found to be cracked beyond daily wear and tear. Toilets were functioning and no bathroom lights were broken or burned out. LPA and Administrator toured the facility and tested the emergency lights which were working as well. LPA also inspected the kitchen, fridge and freezers, and the facility had an adequate food supply for residents.

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.
Exit interview completed and a copy of report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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