<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700233
Report Date: 09/15/2023
Date Signed: 09/25/2023 03:07:46 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
07/19/2023 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230719084358
FACILITY NAME:DAVIS GUEST HOME #8FACILITY NUMBER:
502700233
ADMINISTRATOR:SPEEGLE, MISTYFACILITY TYPE:
740
ADDRESS:5348 KIERNAN AVENUETELEPHONE:
(209) 622-2042
CITY:SALIDASTATE: CAZIP CODE:
95368
CAPACITY:80CENSUS: 78DATE:
09/15/2023
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Zak Davis TIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not adequately staffed to meet the needs of residents in care
Residents are not being accorded dignity in their personal relationships with staff
Facility staff are not receiving adequate training
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/15/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA Pascua was greeted by Facility Designated Administrator, Zak Davis and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above.
Current census was 78. A brief interview with FDA Davis was conducted.
Allegation: Facility is not adequately staff to meet the needs of the residents in care.
It was alleged that the facility is not adquately staffed to meet the needs of the residents in care. During the course of this investigation, LPA conducted interviews and reviewed facility files. LPA conducted 7 staff interviews. 7 out of 7 staff memebrs state that they are able to meet the residents needs and feel that they have enough staff on all shifts. 7 out 7 staff members deny that they are understaffed at this time. LPA interviewed 5 residents. 5 out 5 residents state that they enjoy living at the facility and feel like their needs are being met. 5 out 5 residents deny having any issues with care at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20230719084358
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: DAVIS GUEST HOME #8
FACILITY NUMBER: 502700233
VISIT DATE: 09/15/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on facility records, LPA reviewed the staffing schedule for this facility. It was observed that the facility is staffed for 13 staff members, which include administration personnel, on the AM shift from 7:30am-4:30pm, there are 12 staff members on PM shift from 3:30pm-12:00am and 8 staff members on NOC shift from 12:00am to 8:30am.
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 was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

Allegation: Residents are not being accorded dignity in their personal relationships with staff
It was alleged that the residents are not being accorded dignity in their personal relationships with staff. During the course of this investigation LPA conducted 7 staff and 5 resident interviews. 7 out 7 staff members state that they believe that they treat the residents with respect dignity. 7 out 7 staff members deny every witnessing any other staff members not treat staff with dignity. 5 out 5 residents state that they feel welcome at the facility and deny any staff members not providing them with dignity.
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 was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

Allegation: Facility staff are not receiving adequate training.
It was alleged that the facility staff are not receiving adequate training. During the course of this investigation LPA conducted staff interviews and reviewed facility files. Based on interviews conducted it was learned that this facility holds a new-hire orientation that includes but is not limited to, Personal care services, Physical limitations, psychosocial needs, resident's rights, and policies and procedures regarding medications. After the staff member completes training the staff member is assigned to a "buddy" to follow during the first few shifts to ensure that they are comfortable working with the residents. In addition, staff is provided annual training throughout the year. LPA reviewed staff records which confirm that orientation training and annual training have been conducted for staff.
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 was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.
There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2