502700233-7-10-2023-27-AS-KHOS-CU5LSW-20230727090124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700233
Report Date: 07/10/2023
Date Signed: 07/10/2023 02:40:17 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, 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
04/14/2023 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20230414154005

FACILITY NAME:	DAVIS GUEST HOME #8		FACILITY NUMBER:	502700233
ADMINISTRATOR:	SPEEGLE, MISTY		FACILITY TYPE:	740
ADDRESS:	5348 KIERNAN AVENUE		TELEPHONE:	(209) 622-2042
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	80	CENSUS: 77	DATE:	07/10/2023
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Zachary Davis, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility staff are not providing care and supervision as necessary to meet the resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 7/10/23 at 10:20am to conclude the complaint investigation. LPA met with Zachary Davis, Administrator and stated the purpose of the visit. Upon arrival, LPA observed residents participating in a group activity. LPA reviewed documents submitted to Community Care Licensing (CCL). LPA conducted a random amount of interviews during this visit. LPA observed there is a sink not working in 1 of the public restrooms, however, there are 3 others that are working during this visit. LPA also observed there is 1 showerhead leaking, however, there are 6 others to be used by residents. Administrator has been working on repairing those items prior to todays visit and scheduled repair for this week. Based on interviews with a random amount of Public Guardian offices, Conservators, Residents and staff the investigation revealed that there is an insufficient amount of evidence. Allegation is deemed UNSUBSTANTIATED. A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, copy of report provided.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

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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