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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700729
Report Date: 12/12/2025
Date Signed: 12/12/2025 01:40:32 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
12/08/2025 and conducted by Evaluator Noel Wolf Petersen
COMPLAINT CONTROL NUMBER: 27-AS-20251208105831
FACILITY NAME:YANNICA GUEST HOMEFACILITY NUMBER:
392700729
ADMINISTRATOR:OBTINALLA, MICHELLFACILITY TYPE:
740
ADDRESS:2329 DIAMOND OAKS STREETTELEPHONE:
(209) 565-5873
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 6DATE:
12/12/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Maxima MartineTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff does not accord resident privacy.
Staff is posting videos of residents on social media without resident's consent.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Noel Wolf Petersen arrived unannouced on 12/12/25 at 12:00pm to conduct a complaint investigation into the above allegations. LPA met with administrator, Maxima Martine

LPA asked to review the admission agreement and any attached consents signed at admission. There are videos posted to the Facebook platform by facility staff featuring the facility and two residents for which have the residents have not signed consents to participate in. Administrator Provided there was not a consent form for publishing video of the care home or its residents in the admission agreement, and was aware of the videos and asked for the staff involved to stop.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. 2 citations from the California Code of Regulations,are being cited on the attached LIC 9099D.

A copy of the report was read and given to staff. Appeal rights Provided, and exit interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
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 2
Control Number 27-AS-20251208105831
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: YANNICA GUEST HOME
FACILITY NUMBER: 392700729
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/15/2025
Section Cited
CCR
87468.2(a)(1)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:

(1) To have a reasonable level of personal privacy in accommodations...
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Administrator asked the staff to stop and take down any videos where clients or thier personal information are present by the POC date.
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This requirement was not met as evidenced by: record review and interview where it was learned staff making videos featuring the residents and posting to a public platform without the residents consent.
This poses an immediate risk to the personal rights of the clients in care.
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Type B
12/19/2025
Section Cited
CCR
80068(f)
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80068 Admission Agreements (f) Modifications to the original agreement shall be made whenever circumstances covered in the agreement change, and shall be dated and signed by the persons specified in (c) above.
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Administrator will commit to either revising the admission agreement to include a consent to video recording residents for commercial purposes or enforce a ban of the practice. LPA will be informed of the decision by the POC date and be sent a copy of the updated house rules or consent form.
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This requirement was not met as evidenced by: record review and interview where a consent to be have video taken for comercial purposes was not in the admission agreement.
This posed a potential risk to the personal rights of the clients 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: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2