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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700628
Report Date: 07/19/2023
Date Signed: 07/19/2023 01:04:16 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
COMPLAINT CONTROL NUMBER: 27-AS-20230410145838
FACILITY NAME:G.L.O.M. A.R.F. 5FACILITY NUMBER:
392700628
ADMINISTRATOR:JESSICA OWENSFACILITY TYPE:
772
ADDRESS:458 ALMOND DRIVETELEPHONE:
(209) 330-7155
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:16CENSUS: 15DATE:
07/19/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Alexandria Archangel, Regional Program ManagerTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Residents not being provided medical attention in a timely manner.
INVESTIGATION FINDINGS:
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On 07/19/23, Licensing Program Analyst (LPA) Renee Campbell and LPA Victoria Brown arrived unannounced to the facility at approximately 8:00 am to deliver findings for this complaint. LPA Campbell explained the purpose of the visit to Jasmine Wesson and Alexandria Archangel, Regional Program Manager, who arrived 15 minutes later to assist with todays visit.

LPA Campbell interviewed 2 residents and 2 staff during this visit. On 04/11/23 and 05/19/23 LPA Campbell interviewed additional residents regarding allegation, 'Residents not being provided medical attention in a timely manner’, LPA observed that none of the interviews conducted, corroborated the allegation. Interviews revealed that residents are satisfied with food, get enough to eat and are assured that if they need medical care, they will receive it in a timely manner.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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-20230410145838
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: G.L.O.M. A.R.F. 5
FACILITY NUMBER: 392700628
VISIT DATE: 07/19/2023
NARRATIVE
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The investigation revealed that per interviews clients did not witness any injuries or anyone taken to the hospital. In addition, residents reported not hearing anyone yelling for help. All staff interviewed, reported that residents are taken to the hospital in the case of injury or illness.

Based on interviews, it was determined that there was not a preponderance of evidence that there was a lack of timely medical attention.

As a result of this investigation, it was revealed that the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED. A finding that the complaint is 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.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2