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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 500309303
Report Date: 02/12/2025
Date Signed: 02/12/2025 03:21:39 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
02/05/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250205120513
FACILITY NAME:J & L GUEST HOMEFACILITY NUMBER:
500309303
ADMINISTRATOR:RENEE LITTLEFACILITY TYPE:
740
ADDRESS:237 S ABBIE STREETTELEPHONE:
(209) 527-2765
CITY:EMPIRESTATE: CAZIP CODE:
95319
CAPACITY:32CENSUS: 28DATE:
02/12/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sarah Rico, House ManagerTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident's oxygen tanks were secured in a stand
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/12/25, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced to open a complaint. LPA Campbell met with Sarah Rico, House Manager, and explained the purpose of the visit.
Regarding the allegation that staff did not ensure resident's oxygen tanks were secured in a stand,
LPA Campbell interviewed staff and conducted a search for unsecured oxygen tanks in R1's (R1) room. Staff 1 (S1) stated that R1's oxygen was with them at all times and at night. LPA Campbell also observed R1 with his oxygen in the living room. The tank was a DeVilbiss 5 Liter Oxygen Concentrator which is not an oxygen tank but a method of gathering oxygen from the surroundings and concentrating it for breathing.Emergency oxygen tanks were observed in the locked medicine closet in the office in a stand.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore this allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6 no deficiencies cited. Exit interview was held and a copy of report was given to Sarah Rico.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
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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