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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 471304415
Report Date: 06/12/2026
Date Signed: 06/12/2026 06:25:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
06/04/2026 and conducted by Evaluator Sarah Benson
COMPLAINT CONTROL NUMBER: 59-AS-20260604023515
FACILITY NAME:YREKA GUEST HOMEFACILITY NUMBER:
471304415
ADMINISTRATOR:CRANE, SANDEE JOYFACILITY TYPE:
740
ADDRESS:520 N. MAINTELEPHONE:
(530) 842-4235
CITY:YREKASTATE: CAZIP CODE:
96097
CAPACITY:12CENSUS: 9DATE:
06/12/2026
UNANNOUNCEDTIME BEGAN:
05:03 PM
MET WITH:administrator Sandee Joy CraneTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Staff did not administer medication as prescribed.
INVESTIGATION FINDINGS:
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On June 12, 2026 at 5:00 p.m. Licensing Program Analyst (LPA) Sarah Benson, conducted an unannounced visit and met with administrator Sandee Joy Crane. The purpose of this visit was to open a complaint investigation. During today's visit the facility was toured, records were reviewed and interviews were performed.
LPA interviewed administrator Sandee Joy Crane. LPA reviewed resident medications.

-Substantiated-
Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.
An exit interview was conducted, and a copy of the report and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
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 3
Control Number 59-AS-20260604023515
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YREKA GUEST HOME
FACILITY NUMBER: 471304415
VISIT DATE: 06/12/2026
NARRATIVE
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During medication reviews it was discovered R1 had five out of eight medications with incorrect counts.

During interviews with the administrator it was reported that the residents take their medications every dose every day. During the interview process the administrator stated she had pre-poured medication for the weekend as she will be out of town.

During record review it was discovered the staff had online medication training.




Continued on LIC9099D
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 59-AS-20260604023515
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: YREKA GUEST HOME
FACILITY NUMBER: 471304415
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/13/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.
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The administrator will have a professional medication training for all staff.
The administrator will write a paper of the understanding of medication administration best practices.
Administrator will submit a plan for periodic audits of medication.
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Based on observation, the licensee did not comply with the section cited above. The licensee shall assist residents with self-administered medications as needed. The residents medication administration counts are incorrect. Which poses/posed a potential health, safety or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3