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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700752
Report Date: 05/05/2022
Date Signed: 05/05/2022 03:16:03 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-20220321110056
FACILITY NAME:G.L.O.M. A.R.F. 6FACILITY NUMBER:
392700752
ADMINISTRATOR:ANTHONY ISBELLFACILITY TYPE:
735
ADDRESS:404-408 E. PINE STTELEPHONE:
(209) 330-7155
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:46CENSUS: 39DATE:
05/05/2022
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Peggy Phelps, DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Excluded individual is present at the facility
Facility is in financial distress
INVESTIGATION FINDINGS:
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On 05/05/2022 at 1:55 pm, Licensing Program Analyst (LPA) T. White arrived unannounced to open and investigate the complaint allegation noted above. LPA met with Director, Peggy Phelps and explained the purpose of the visit.

During course of investigation, LPA interviewed 4 clients and 5 staff members. Based on 4 of 4 clients and 4 of 5 staff members the excluded individual was present at facility. 3 of 5 staff members stated excluded individual was present at the facility on 03/29/2022. Staff #2 (S2) stated the excluded individual came to the facility on 03/29/2022 to speak to clients and staff members.

Report continues on 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
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 3
Control Number 27-AS-20220321110056
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: 05/05/2022
NARRATIVE
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Financial Distress

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 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-20211201131833.

An exit interview conducted with Administrator. A copy of report and Appeal rights given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 27-AS-20220321110056
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/13/2022
Section Cited
CCR
80019(a)(2)(E)
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80019: Criminal Record Clearance:(a)The Department shall conduct a criminal record review of all individuals.. (2)Section 1522(b) of the Health and Safety Code... (E)If the applicant is... the chief executive officer... This requirement was not met as evidence by:
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Director agreed to submit a written plan of correction informing CCLD excluded individual will no longer be present at facility or have contact with clients. Director agreed to submit written plan by 05/13/2022.
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Based on LPA observation, licensee did not comply with the section cited above in 80019(a)(2)(E. Based on interviews, 4 of 5 staff members and 4 of 4 clients stated excluded individual was present at the facility which poses an immediate health and safety risks to clients in care
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Civil penalty assessed today for facility allowing an excluded person in facility.
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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: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3