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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 500305863
Report Date: 01/02/2025
Date Signed: 01/02/2025 10:02:50 AM

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
08/08/2024 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20240808070850
FACILITY NAME:GEORGIA'S GUEST HOMEFACILITY NUMBER:
500305863
ADMINISTRATOR:GEORGIA WILCOMBFACILITY TYPE:
740
ADDRESS:102 SOUTH G STREETTELEPHONE:
(209) 529-7872
CITY:EMPIRESTATE: CAZIP CODE:
95319
CAPACITY:15CENSUS: 12DATE:
01/02/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Georgia Wilcomb, AdministratorTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Facility staff not following admissions agreement
Facility staff not ensuring residents have access to hygiene items
INVESTIGATION FINDINGS:
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On 01/02/2024, Licensing Program Analyst Renee Campbell arrived to the facility to deliver findings regarding a complaint. LPA Campbell was met by Georgia Wilcomb, Licensee and explained the purpose of the visit.

In regards to the allegation that staff are not following admissions agreements to arrange transportation for medical visits, C4 and C1 reported that staff arrange transportation or the doctor comes to the home for medical examinations. C2 reported that her daughter comes to take her to the doctor. When asked, the clients interviewed stated they had not been taken to doctor’s appointment via ambulance.

In regards to the allegation that staff are not ensuring residents have access to hygiene items, C4 reported that she never knew where the soap or tissue came from, since "they just always had it." C1 also stated that “They provide soap and tissue. This is a real nice place.” And C3 confirmed this. LPA Campbell also observed that incontinence pads were stored in a storage shed in the carport.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
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-20240808070850
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: GEORGIA'S GUEST HOME
FACILITY NUMBER: 500305863
VISIT DATE: 01/02/2025
NARRATIVE
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Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited. Exit interview was held and a copy of report was given to Georgia Wilcomb
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2