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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500305863
Report Date: 10/23/2023
Date Signed: 10/31/2023 02:34:57 PM


Document Has Been Signed on 10/31/2023 02:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HOMEFACILITY NUMBER:
500305863
ADMINISTRATOR:GEORGIA WILCOMBFACILITY TYPE:
740
ADDRESS:102 SOUTH G STREETTELEPHONE:
(209) 529-7872
CITY:EMPIRESTATE: CAZIP CODE:
95319
CAPACITY:15CENSUS: 9DATE:
10/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Georgia WilcombTIME COMPLETED:
03:00 PM
NARRATIVE
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Unannounced case management visit made out to this facility on 10/23/2023 by Licensing Program Analyst (LPA) Charlie Yang and Regional Manager (RM) Stephenie Doub. LPA Yang was met by the facility Licensee Georgia Wilcomb.
Current census was 9 residents.
Also present were representatives from the Senate committee, County officials, and members from Patients' Rights.
The purpose of this visit was to tour this facility, along with the above members, since consideration was being made for financial review in assisting this facility to upgrade its physical plant to continue compliance with Title 22 Rules and Regulations.
Brief interview was also conducted with the facility Licensee Georgia Wilcomb at this time.

Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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