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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 500305863
Report Date: 07/08/2025
Date Signed: 07/08/2025 06:08:18 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
07/01/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250701085336
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: 10DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Georgia Wilcomb, LicenseeTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff do not ensure residents are provided clean clothing to wear while in care
Staff engages in inappropriate conversations with other adults while in the presence of residents in care
Staff do not ensure resident are provided snacks in between meals
Staff do not arrange transportation for residents medical appointments
INVESTIGATION FINDINGS:
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On 07/08/2025, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to open a complaint investigation. LPA Campbell met with Licensee Georgia Wilcomb and explained the purpose of the visit.

Regarding the allegation that staff do not ensure residents are provided clean clothing to wear while in care, upon entry to the community, LPA Campbell observed Licensee Wilcomb doing laundry in the laundry room. When interviewed, R1, R2 and R3 reported that staff do their laundry and that staff do not want them in the laundry room. LPA Campbell observed residents wearing clothes in good repair, without stains and observed no odors in bedrooms.

Regarding the allegation that staff engages in inappropriate conversation with other adults while in the presence of residents in care, none of the residents interviewed stated witnessing or hearing about staff discussing inappropriate topics. R2 stated “I don’t even hear them talking about each other and that’s rare with staff”.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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-20250701085336
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: 07/08/2025
NARRATIVE
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Regarding the allegation that staff do not ensure residents are provided snacks between meals, R1, R2 and R3 were asked if they have access to snacks. Residents interviewed stated they felt free to take snacks from the kitchen when they were hungry. This abides by regulation 87464 (f)(3) which states that three snacks be “made available daily” to residents in care of the community. LPA Campbell also observed an abundance of foods in an outside cabinet and refrigerator that were accessible to residents. LPA Campbell observed a resident go outside and grab food from a refrigerator.

Regarding the allegation that staff do not arrange transportation for residents medical appointments, R1, R2 and R3 all reported that staff will arrange transportation with Lyft, Dial a Ride or arrange it through their insurance provider. They reported no issues getting to their appointments. There are also six residents who receive medical care through their primary physician who conducts home visits in the community. Per the residents interviewed and their Medication Administration Record (MAR) Unless requested otherwise, the community orders medication refills and disperse the medication as directed by their doctors.

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: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
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