500305863-5-18-2023-27-AS-LKIG-CSBLE7-20230530084102

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500305863
Report Date: 05/03/2023
Date Signed: 05/18/2023 05:07:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
11/18/2022 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221118105126

FACILITY NAME:	GEORGIA'S GUEST HOME		FACILITY NUMBER:	500305863
ADMINISTRATOR:	GEORGIA WILCOMB		FACILITY TYPE:	740
ADDRESS:	102 SOUTH G STREET		TELEPHONE:	(209) 529-7872
CITY:	EMPIRE	STATE: CA	ZIP CODE:	95319
CAPACITY:	15	CENSUS: 10	DATE:	05/03/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Steven Paul Hardin		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff does not ensure resident's are fed.

Staff does not allow resident to shower.

Staff is not addressing pest infestation.

Staff does not provide quality food.

Staff are retaliating against resident for a previous complaint resident submitted.

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 05/03/2023 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Viarella who were met by the facility designated Administrator Steven Paul Hardin.
Current census was 10 residents.
The purpose of this visit was to deliver the findings from this complaint investigation for the above allegations at this time.
Based on interviews and information gathered during the course of this investigation, it was observed that the facility food supply was sufficient to meet the 2-day perishable and 7-day non perishable food supply requirements at this time. A review of the food items was conducted for the interior food storage units, as well as, the exterior food storage units as well. There were no expired food items observed for the perishable foods nor the non perishable food supply. It was observed that meals were prepared, and offered, for all (3) meals (breakfast, lunch and dinner) throughout the day. Facility residents were called to eat when it was meal time and plates were set aside for residents who either preferred to eat in their rooms or were currently out of the facility during meal times.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20221118105126

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: GEORGIA'S GUEST HOME	FACILITY NUMBER: 500305863
	VISIT DATE: 05/03/2023

NARRATIVE

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It was observed that the facility showers were functional and in good repair at this time. It was learned that facility residents were requested by facility staff to adhere to a certain shower schedule for male and female residents so as to avoid everyone attempting to take a shower all at once. In addition, it was structured so that facility residents were not taking showers too early in the day, as well as, not taking showers too late at night while facility residents were trying to sleep.
It was learned that facility staff did not enforce the shower schedule on the facility residents but used it as a guide for residents to avoid confusion and everyone trying to shower all at the same time.
It was learned that facility staff would never turn away a resident attempting to shower but had more difficulty attempting to get residents to go take a shower and maintain proper hygiene.
It was learned that this facility was contracted, and currently receiving services, from a licensed pest control company to address the issues of mice, cockroaches, and other potential pests that may come into this facility at this time.
It was learned that facility staff and potential residents were having personal issues outside of providing adequate care and supervision at this time. From these interactions, these relationships were strained with accusations going back and forth without any real basis for validity.
Facility residents, overall, felt that they were being treated with concern and care by the facility staff. Facility residents felt that they could approach the facility staff if they had any issues or concerns without prejudice or fear of retaliation if their concerns were voiced.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited during today's complaint visit.

Exit Interview

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

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