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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700752
Report Date: 07/23/2025
Date Signed: 07/23/2025 11:06:28 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2025 and conducted by Evaluator Noel Wolf Petersen
COMPLAINT CONTROL NUMBER: 27-AS-20250623144645
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: 44DATE:
07/23/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Alex ArchangelTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide resident with toothbrush/tooth paste as a form of punishment
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/23/25 at 8:00am Licensing Program Analyst(LPA) Noel Wolf Petersen met with staff Gerardo Varela and Administrator Alex Archangel at G.L.O.M. 6 and explained the purpose of the visit: to deliver findings of a complaint investigation.

It was alleged that Staff did not provide resident with toothbrush/tooth paste as a form of punishment. Interviews with staff member, managers, residents, yielded conflicting statements about the matter. No record of the incident was made in the shift notes. LPA observed a pattern of limiting access to personal items as a common practice in the facility, although not specifically hygiene products. Technical assistance was provided regarding Personal Rights of the Residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted. A copy of the report was read and given to the administrator, no citations were issued per title 2. Appeal rights were provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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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