507001000-2-7-2024-27-AS-KHOS-D2LR6M-20240219114457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507001000
Report Date: 12/04/2023
Date Signed: 02/07/2024 03:15:16 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
11/16/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20231116123740

FACILITY NAME:	DAVIS GUEST HOME #3		FACILITY NUMBER:	507001000
ADMINISTRATOR:	HEATHER MCCLOSKY		FACILITY TYPE:	740
ADDRESS:	1628 NADINE AVENUE		TELEPHONE:	(209) 538-1346
CITY:	MODESTO	STATE: CA	ZIP CODE:	95351
CAPACITY:	10	CENSUS: 10	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Heather McClosky		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not treat resident with dignity and respect.
Facility smells of marijuana.
Staff provide care and supervision while under the influence of marijuana

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 12/04/23, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to this facility at approximately 2:00 PM to present findings for a complaint investigation. LPA met with Heather McClosky, Administrator, and explained the purpose of the visit.

Regarding the allegation that staff do not treat residents with dignity and respect, based on interviews with 10 residents, R1, R3, R4, R5, R9 and R10 did not report disrespect or shouting from staff. When questioned, R3 acknowledged that staff had cursed but it was not confirmed staff cursed at residents. Based on the result of this investigation, there is not a preponderance of evidence to prove the alleged violation occurred. The Department therefore finds the allegation to be UNSUBSTANTIATED.

Regarding the allegation that the facility smelled of marijuana, LPA Campbell visited the facility and did not observe the smell of marijuana. Regarding the allegation that staff provide care and supervision while under the influence of marijuana, based on staff interviews with R1 (Resident #1) to R10, 8 residents and

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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-20231116123740

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DAVIS GUEST HOME #3	FACILITY NUMBER: 507001000
	VISIT DATE: 12/04/2023

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

3 staff reported that no current staff had been seen smoking marijuana on the premises and R10 reported that they smelled marijuana that came from the neighbors and not the facility. R3 explicitly stated that while there had been staff who had used marijuana in the past, there were no people on staff currently who used it.
Therefore, the preponderance of evidence standard has not been met and the allegation is unsubstantiated. Although the allegations may have happened or be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Heather McClosky. No deficiencies are being cited at this time, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2