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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507002305
Report Date: 03/28/2022
Date Signed: 03/28/2022 12:54:13 PM

Substantiated


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
03/21/2022 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 27-AS-20220321145859
FACILITY NAME:GARDE'S GUEST HOMEFACILITY NUMBER:
507002305
ADMINISTRATOR:IRENE GARDEFACILITY TYPE:
735
ADDRESS:3728 BRIDGEFORD LANETELEPHONE:
(209) 569-0625
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:6CENSUS: 6DATE:
03/28/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Irene Garde TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff do not allow residents to use a facility restroom
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on March 28, 2022 at 11:00 a.m. to investigate the above allegations. LPA met with facility Licensee Irene Garde and explained the purpose of today’s visit.

Regarding the allegations staff do not allow residents to use a facility restroom. Based on LPA interviews and records reviewed the licensee is not allowing residents to use one of the facility restrooms. LPA reviewed the facility sketch and one of the bathrooms is labeled as staff bathroom, but is still included in the facility area that should be accessible to residents. Licensee Irene Garde stated she recently started locking the staff bathroom because residents were taking so long to use the main restroom. Therefore, this allegation is SUBSTANTIATED.

The following deficiencies were cited per Title 22 Division 6. An exit interview was conducted with Licensee Irene Garde and a copy of this report was left at the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
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-20220321145859
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: GARDE'S GUEST HOME
FACILITY NUMBER: 507002305
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2022
Section Cited
CCR
85088(b)(1)
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85088(B) Fixtures, Furniture, Equipment and Supplies (1) At least one toilet and washbasin shall be maintained for each six persons residing in the facility, including clients, family and personnel. This requiremenet has not been met as evidenced by:
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Licensee unlocked the staff restroom in presence of LPA and agreed to leave unlocked.
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Based on interview with Licensee the facility only has one restroom for all residents as she has been locking the extra bathroom causing residents to have to go outside to use restroom, which posses a health, safety or pesonal rights risk to residents in care.
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ILS
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2