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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 480111090
Report Date: 08/30/2021
Date Signed: 08/30/2021 12:14:57 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2021 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20210608130228
FACILITY NAME:GILCREST GROUP HOME, THEFACILITY NUMBER:
480111090
ADMINISTRATOR:CHERYL DAVIDSONFACILITY TYPE:
735
ADDRESS:447 GILCRESTTELEPHONE:
(707) 563-5543
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:9CENSUS: 7DATE:
08/30/2021
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Jackie MorrisTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide care and supervision necessary to meet the needs of resident(s).
Staff did not provide quality meals to meet the needs of resident(s).
Staff did not answer communications to the authorized representative promptly and completely
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 11:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegations. LPA met with house manager Jackie Morris, reviewed records and interviewed clients. Based on a review of records, all clients are able to be in the community unsupervised and are able to communicate their needs. Clients have a log book where they sign in and out. LPA received photographs of meals served to clients and interviewed 3 clients who were in the living room. Clients stated they love the food at the facility. LPA spoke with Administrator via the telephone and was informed they respond to all responsible parties as soon as possible. LPA was not able to determine an instance where a communication was not responded to in a timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. No citations issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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