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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005009
Report Date: 09/17/2025
Date Signed: 09/17/2025 02:39:45 PM

Substantiated


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
08/14/2025 and conducted by Evaluator Cynthia Tamayo
COMPLAINT CONTROL NUMBER: 27-AS-20250814112509
FACILITY NAME:GENE-LYN GUEST HOME, INC.FACILITY NUMBER:
347005009
ADMINISTRATOR:GRACE QUIEREZFACILITY TYPE:
740
ADDRESS:7814 NEYLAND WAYTELEPHONE:
(916) 236-3978
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 3DATE:
09/17/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Magie QuirezTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee did not ensure that resident's records were readily available as necessary.
Staff cannot communicate due to language barrier.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to complete and close up the complaint investigation for the allegations listed above. LPA Cynthia Tamayo met with facility Licensee, Magie Quirez and explained the purpose of the visit.

It was alleged Licensee did not ensure that resident's records were readily available as necessary.
Based on the interviews and cord reviews obtained during the investigation process, the allegations have been corroborated. On 8/13/2025, the local fire department responded to a 911 call made by Resident 1's (R1's) visiting family members (P1, P2, and P3), due to R1 "not being responsive". R1 moved into the facility on 8/10/25. When emergency personnel requested resident records, the records were not immediately available. Records were provided when licensee (S1) arrived to the facility a five to ten minutes after emergency personnel arrived, at which point the requested records were provided. Interviews with witnesses corroborate resident records were locked and the licensee (S1) provided the documents when they arrived to after Sacrament Metro Fire Department (SMFD) had arrived.
Continued on 9099-D
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Cynthia Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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 3
Control Number 27-AS-20250814112509
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: GENE-LYN GUEST HOME, INC.
FACILITY NUMBER: 347005009
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2025
Section Cited
CCR
87506(a)
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87506( (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
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Licensee will review regulation and submit a statment of understanding to the department by 9/24/2025 to cynthia.tamayo@dss.ca.gov. Licensee will ensure resident records are complete upon admission and are accessible to staff.
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This requirement is not met as evidenced by a delay in providing resident records to emergency personnel when requested. This poses an immediate health, and safety risk to residents in care.
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Type B
09/24/2025
Section Cited
CCR
87411(a)
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7411 Personnel Requirements - General (a) Facility personnel shall at all times be ... competent to provide the services necessary to meet resident needs. ... to ensure provision of personal assistance and care as required in Section 87608...
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Licensee will review regulation and submit a statment of understanding to the department by 9/24/2025 to cynthia.atamayo@dss.ca.gov. Licensee they will train staff on communication and emergency procedures.
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This requirement is not met as evidenced by staff's inability to communicate effectivly especially in emergency situations. This poses a potential health, and safety risk to residents in care.
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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: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Cynthia Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20250814112509
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: GENE-LYN GUEST HOME, INC.
FACILITY NUMBER: 347005009
VISIT DATE: 09/17/2025
NARRATIVE
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Interviews and record review confirm R1 did not have a POLST, only an advanced directive.

It was alleged Staff cannot communicate due to language barrier.
Based on the interviews and statements obtained during the investigation process, the allegations have been corroborated. LPA interviewed S2 and S3, whom where working on 8/13/25. Staff were not able to communicate fluently in English. When asked about resident history and care needs, staff where unable to provided complete and accurate responses. Witness interviews corroborate S3 and S2 were not able to give medical history, report on R1's condition, or baseline of R1 to emergency personnel.

The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation that Licensee did not ensure that resident's records were readily available as necessary is substantiated. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation that staff cannot communicate due to language barrier is substantiated.

Two deficiencies were cited per California Code of Regulations, TITLE 22, which can be found on LIC 9099-D. Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Cynthia Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3