500305863-9-4-2025-27-AS-LRIS-DLYR4T-20250929124205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500305863
Report Date: 09/04/2025
Date Signed: 09/04/2025 05:38:16 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
06/05/2025 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20250605110837

FACILITY NAME:	GEORGIA'S GUEST HOME		FACILITY NUMBER:	500305863
ADMINISTRATOR:	GEORGIA WILCOMB		FACILITY TYPE:	740
ADDRESS:	102 SOUTH G STREET		TELEPHONE:	(209) 529-7872
CITY:	EMPIRE	STATE: CA	ZIP CODE:	95319
CAPACITY:	15	CENSUS: 10	DATE:	09/04/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Georgia Wilcomb, Licensee		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff does not ensure resident is taking prescribed medications.
Staff does not ensure resident's medication is refilled in a timely manner.
Staff does not ensure resident's medical needs are being met.
Staff are abusing residents in care.

INVESTIGATION FINDINGS:

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On 09/04/2025, Licensing Program Analyst (LPA) Renee Campbell arrived at the community to complete an investigation and present findings. LPA Campbell met with Georgia Wilcomb, Licensee and explained the purpose of the visit. Upon entry, LPA Campbell observed the licensee speaking with residents and working in the kitchen cleaning.

Regarding the allegation thats staff does not ensure resident is taking prescribed medications and that staff does not ensure resident's medication is refilled in a timely manner, LPA Campbell interveiwed R1 and R2. Both residents reported that when staff offer medications, they take it and neither R1 or R2 refuse the medications. LPA Campbell reviewed the Medication Administration Record (MAR) and found no refusal of medications recorded. Of the 11 residents present in the facility, R1 is the only resident whose medication is not refilled automatically. The licensee and F1 confirmed during separate interviews that F2 had been unable to pick up a refill on time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250605110837

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: 09/04/2025

NARRATIVE

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Regarding the allegation that staff does not ensure residents medical needs are being met, the facility has a doctor that makes house calls who can also be called for assessments as needed. The licensee has taken R1 to the eye doctor and R3 to the cardiologist. LPA Campbell observed the facility appointment calendar that is used to track medical appointments and visits for the community. R4 stated that they had been taken to have a mammogram and for lab work. When LPA Campbell spoke with F1 regarding a residents need for blood pressure, it was confirmed that the resident had no doctors orders on file and that the resident no longer needed their blood pressure taken.

Regarding the allegation that staff are abusing residents in care, LPA Campbell spoke with R1, R2 and R3. None of the residents interviewed mentioned verbal or physical abuse and stated that staff treated them well.

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, Chapter 8,no deficiencies cited. Exit interview was held and a copy of report was given to Georgia Wilcomb, Licensee.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

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