392700752-3-11-2022-27-AS-LKIG-CCMMZW-20220318100347

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700752
Report Date: 03/11/2022
Date Signed: 03/11/2022 03:05:18 PM

Unsubstantiated

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
03/10/2022 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20220310083128

FACILITY NAME:	G.L.O.M. A.R.F. 6		FACILITY NUMBER:	392700752
ADMINISTRATOR:	ANTHONY ISBELL		FACILITY TYPE:	735
ADDRESS:	404-408 E. PINE ST		TELEPHONE:	(209) 330-7155
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	46	CENSUS: 33	DATE:	03/11/2022
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Anthony Isbell		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Not enough food for residents in care
Facility does not have enough hot water for residents in care

INVESTIGATION FINDINGS:

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

On 3/11/22 at 12:25pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate a complaint for the allegations noted above. LPA met with program administrator Anthony Isbell and explained the purpose of the visit. LPA conducted a health and safety check of facility, reviewed facility's menu and requested a client and staffing roster. LPA also interviewed program administrator, staff1 (S1), S2, S3, and S4. LPA also interviewed resident1 (R1), R2, R3, and R4. LPA observed lunch service to clients at 1:15pm. There are currently 33 clients in care. During health and safety check, it was determined that facility is clean and sanitary throughout. No foul odors noted. No obstructions to fire exits. All toxins, sharp objects, and other dangerous items are inaccessible to clients in care. Facility temperature was adequate and within 68*F - 85*F. Food storage was observed by LPA to be adequate and meet the 2 days of perishables and 7 days of non-perishables supply regulatory minimum including adequate supplies of fruits, vegetables, and beverage items. At 1:15pm, LPA observed lunch service providing clients with food items matching the scheduled menu items. Additionally, food items noted in storage were adequate to meet the menu as stated. Menus observed by LPA were dated from 2/13/22 to 3/12/22. {Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

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-20220310083128

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. 6	FACILITY NUMBER: 392700752
	VISIT DATE: 03/11/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Food observed in storage included but not limited to: Meats, milk, eggs, vegetables, fruits, beans, rice, cereal items, juice, and canned foods. LPA did not observe any expired food or inappropriately stored food during visit. Emergency food supply was observed by LPA to be adequate to meet clients' needs. LPA also observed additional food prepared for clients who desired additional portions. LPA allowed hot water to run in bathroom shower for 15-20 minutes. Hot water was not compromised during LPAs visit and appeared to be of adequate amount. Temperature of hot water is between 105*F to 120*F regulatory requirement,.

Interviews with S1 to S4 revealed that facility is meeting the minimum food supply for clients in care and matching the menu items. Interviews with S1 to S4 also revealed no expressed concerns regarding hot water availability for clients in care. Interviews with R1 to R4 revealed that enough food is being served to clients including beverages, fruits, and vegetables and no concerns of food shortages. Interviews with R1-R4 also revealed food is available to meet menu items. No concerns were expressed through interviews with R1-R4 regarding hot water. It was revealed through these interviews that there is no shortage of hot water.

Interview with program administrator revealed that shopping is conducted every other Tuesday with a budget of $3000-$3600. Program administrator also stated that additional shopping trips are conducted as needed to meet the regulatory food requirement amounts.

Based on interviews, observation, and record reviews it is determined that the preponderance of evidence standard is not met. Therefore this allegation is UNSUBSTANTIATED.

No deficiencies are cited during today's visit. An exit interview was conducted with Anthony Isbell and a copy of this report was left with Anthony.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2