<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850527
Report Date: 07/09/2026
Date Signed: 07/09/2026 01:09:33 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/08/2026 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20260708095923
FACILITY NAME:WELCOME HOME ATASCADEROFACILITY NUMBER:
405850527
ADMINISTRATOR:JESSICA GUERREROFACILITY TYPE:
740
ADDRESS:14900 EL CAMINO REALTELEPHONE:
(805) 703-4686
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:60CENSUS: 26DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Jessica Guerrero, AdministratorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not maintain facility free from hazards
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) De Leon conducted a 10-day complaint visit to the facility above. LPA met with Jessica Guerrero, Administrator and explained the purpose of the visit.

LPA requested a staff roster, staff schedule, and resident roster. LPA requested to see the housekkeeping cart and took photographs of the cart. LPA interviewed staff at 11:00am, 11:10am, 12:06pm, and 12:13pm.

On the allegation: Staff do not maintain facility free from hazards. LPA took photographs of the housekeeping carts for mopping the floor the cart had 4 wet floor signs, gloves, cleaning products, cleaning rags, trash bag, mop and mop bucket. LPA observed the dining room being mopped, the area was ropped off, wet floor signs were present, no residents were present and no safety risks were observed. Continued 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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 29-AS-20260708095923
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: WELCOME HOME ATASCADERO
FACILITY NUMBER: 405850527
VISIT DATE: 07/09/2026
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
According to witness 1 (W1), W1 arrived at work and almost slipped on the wet floor. W1 stated there were not signs posted the floor was wet. W1 felt it could have been a safety risk to residents in care. W1 did not ask the staff to put up a sign. W1 did not inform supervisor or management of a safety concern.

According to Administrator the staff mopping have signs on carts and should be putting them up when wet floors are present to help mitigate any safety hazards. The Administrator stated no staff on 07/07/2026 brought that to Administrators attention so it could have been dealt with and a sign posted. Administrator stated there were no reports of any slips or falls by any staff, residents or visitors that day. Administrator will hold a staff meeting to go over hazards, safety and requirements of staff reporting.

Staff 1's (S1) interview revealed the housekeeping staff is under Maintenance Director and the housekeeping carts have signs to put up when mopping, S1 did not get any complaints from staff in regards to a sign not being posted in the area of the wet floor and said the staff mopping is suppose to post a sign.

Staff 2's (S2) interview revealed S2 does housekeeping was working on 07/07/2026, S2 did mop on 07/07/2026 but can not recall if S2 had put out signs or not but S2 normally does. S2 said if a sign was not posted it was in error and S2 did not mean to cause a safety concern or had any intention of causing danger to anyone, S2 said if a sign was not posted no one said anything to S2 to about it and had someone said something S2 would have immediately put signs out, if signs were not already posted.

Staff 3's (S3) interview revealed S3 does housekeeping, was working on 07/07/2026 and always puts out signs when mopping, at the beginning of where the mopping started and at the end of where the mopping stopped, S3 said the carts always has 3-4 signs on it to use and when S3 has trained other staff it has been a point to train staff to put out signs when the floor is wet. S3 never noticed anyone else mopping without putting a sign up and S3 said it is a safety concern and the staff that slipped should have notified a supervisor immediately so a sign could have been posted, if there was not already a sign posted, S3 said no one reported a fall or slip on wet floor to the staff on 07/07/2026, S3 said this should have been reported to avoid any hazards with residents, visitors, kids and families that visit the facility.
Based on a lack of evidence and no residents, visitors or staff reported any hazards to the facility on 07/07/2026, therefore this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2