500305863-5-18-2023-27-AS-LKIG-CSBLG6-20230530084415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500305863
Report Date: 05/03/2023
Date Signed: 05/18/2023 05:40:39 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
02/22/2023 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230222135432

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:	02:00 PM
MET WITH:	Steven Paul Hardin		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Unknown perpetrator is harassing resident in care.

Staff do not safeguard resident's personal items.

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 the information gathered during this investigation, 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.
It was learned that facility residents did not feel that they were harassed or being mistreated by the facility

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-20230222135432

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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staff at any given time.
It was learned that there were no incidents or issues with theft within this facility. It was learned that facility residents were able to leave their bedroom doors open, without locks, and did not feel that their belongings would ever go missing.

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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