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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397001458
Report Date: 09/08/2021
Date Signed: 09/08/2021 04:04:13 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
08/30/2021 and conducted by Evaluator Bruce Jacobs
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20210830140627
FACILITY NAME:TACSION'S GUEST HOME #3FACILITY NUMBER:
397001458
ADMINISTRATOR:TACSION, ROBERTFACILITY TYPE:
735
ADDRESS:2344 WAGNER HEIGHTSTELEPHONE:
(209) 952-6037
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 5DATE:
09/08/2021
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Vilma De LeonTIME COMPLETED:
09:10 AM
ALLEGATION(S):
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Food services are inadequate.
INVESTIGATION FINDINGS:
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LPA Bruce Jacobs conducted an unannounced complaint visit at the facility and met with Facility Manager Vilma De Leon spoke to Administrator Myrna Tacsion by phone to discuss and complete this complaint investigation. LPA provided findings regarding the allegation listed above. The investigation was conducted by LPA Jacobs and consisted of reviews of the facility records and menus and interviews with facility management and staff. and clients.

The complaint allegation listed above was investigated. The residents, facility staff and management and other witnesses were interviewed by LPA Jacobs on 8/31/21.. The residents and all other individuals interviewed denied that the facility's food service is inadequate. Other witnesses interviewed provided conflicting information on this allegation.

During LPA's inspection food supply and menus were observed. Based on all i, interviews and observations, this allegations is determined 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 evidence to prove that the alleged violations occurred.
Continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
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-20210830140627
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: TACSION'S GUEST HOME #3
FACILITY NUMBER: 397001458
VISIT DATE: 09/08/2021
NARRATIVE
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Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are determined to be UNSUBSTANTIATED.

Exit interview conducted, report provided to the Facility Manager
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2