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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005745
Report Date: 01/10/2023
Date Signed: 02/17/2023 11:55:30 AM

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
12/12/2022 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20221212123643

FACILITY NAME:TKAS GUEST HOMEFACILITY NUMBER:
397005745
ADMINISTRATOR:KOKUMO, ADETAYOFACILITY TYPE:
735
ADDRESS:4327 ROMA LANETELEPHONE:
(209) 983-5040
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 5DATE:
01/10/2023
UNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Tayo TIME COMPLETED:
02:59 PM
ALLEGATION(S):
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Lack of staff supervision resulting in residents using illegal drugs in the facility
Lack of staff supervision resulting in residents sale of illegal drugs from the facility
INVESTIGATION FINDINGS:
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Allegation: Lack of staff supervision resulting in residents using illegal drugs in the facility. Based on interviews conducted and records reviewed the facility has staff on site 24/7. The facility staff and other residents deny witnessing, smelling or participating in any illegal use of drugs at or in the facility.

All residents interviewed confirmed that they do smoke tabacco and marijuina, but confirm that they have smoking areas for them to use. Residents also confirmed that they follow the house rules for smoking and have not had a problem with staff regarding enforcing of the smoking rules.

Continued
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20221212123643
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: TKAS GUEST HOME
FACILITY NUMBER: 397005745
VISIT DATE: 01/10/2023
NARRATIVE
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Allegation: Lack of staff supervision resulting in residents sale of illegal drugs from the facility. Based on interviews with the Staff and Residents at the facility all interviewed denied witnessing or being part of the sale of illegal drugs in or around the facility.

Residents confirmed that some resident's smoke marijuana, but all denied using, witnessing or selling cocaine at / or around the facility. All staff interviewed denied using, witnessing or selling cocaine at /or around the facility. LPA was unable to establish a date or time when the alleged illicit actives happened.

The preponderance of evidence standards has not been met. Therefore, the allegations are UNSUBSTANTIATED.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no violations were cited during this visit.

An exit interview was conducted
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3