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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507005360
Report Date: 01/26/2024
Date Signed: 03/29/2024 03:05:05 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
12/21/2023 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20231221125013
FACILITY NAME:ST. FRANCIS GUEST HOMEFACILITY NUMBER:
507005360
ADMINISTRATOR:ESTHER TOLIAOFACILITY TYPE:
740
ADDRESS:664 PARADISE ROADTELEPHONE:
(209) 622-0295
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:12CENSUS: 10DATE:
01/26/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:John Villareal, ManagerTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide medication as prescribed
Staff did not seek medical attention for resident in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
A visit was conducted on 03/29/24 to amend the document from the 01/26/24 visit. The document below is an amendment to the prior report.

On 01/26/24, Licensing Program Analyst Renee Campbell made an unannounced visit to the facility at 9 am. LPA Campbell was met by John Villareal, Manager and Sharon Basaldua, Caregiver and explained the purpose of the visit. The facility Administrator Esther Taliao was not present. The current census is 10.

Regarding the above allegations, based on interviews and record reviews, R1 was unable to confirm medication was received incorrectly or that their medical needs were not met. When LPA Campbell interviewed R1, LPA Campbell observed that R1 was unable to answer questions or recall having a seizure. R1 was unable to share or to remember why a complaint had been made. Record reviews and additional interviews with R2 and R3 also did not support allegations of inappropriate medical care.

Based on the result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
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 1