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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700233
Report Date: 04/13/2026
Date Signed: 04/13/2026 11:00:46 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
11/24/2025 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20251124150722
FACILITY NAME:DAVIS GUEST HOME #8FACILITY NUMBER:
502700233
ADMINISTRATOR:THOMAS, ARIELFACILITY TYPE:
740
ADDRESS:5348 KIERNAN AVENUETELEPHONE:
(209) 622-2042
CITY:SALIDASTATE: CAZIP CODE:
95368
CAPACITY:80CENSUS: 80DATE:
04/13/2026
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Admistrator Ariel ThomasTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Staff did not do an inventory of a resident's personal belongings

Staff did not keep facility free of insects

Staff withheld resident's money
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund met with Admistrator Ariel Thomas and explained the reason for the visit. Census: 80

Staff did not do an inventory of a resident's personal belongings- Based on records reviewed, staff interviewed, and interview with reporting party. The facility did initial Client/Resident Personal Property & Valuables with Resident (R1) on 3/11/2025. The facility did follow up Client/Resident Personal Property & Valuables with Resident checks on 4/16/20205 and 6/18/2025. R1 stated that no valuables were missing.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026
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-20251124150722
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: DAVIS GUEST HOME #8
FACILITY NUMBER: 502700233
VISIT DATE: 04/13/2026
NARRATIVE
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Based on records reviewed, staff interviewed, and interview with reporting party the information provided, it was unclear if staff did not do an inventory of a resident's personal belongings therefore the allegation was deemed UNSUBSTANTIATED.

Staff did not keep facility free of insects- Based on records reviewed, interviews with Staff, Reporting Party and Resident’s in care. LPA Lund observed the facility free on insects during visits on 8/15/2024, 9/17/2025, 12/1/2025 and 12/29/2025. The facility has Total Pest Management and does regulatory visits once a month. LPA Lund reviewed Total Pest Management invoices for 9/19/2025 and 10/22/2025. Staff interviewed stated that they have not seen insects inside the facility. Residents in care stated they have not seen insects inside of the facility.

Based on records reviewed, interviewed Staff, Reporting Party and Resident’s in care on the information provided, it was unclear if staff did not keep facility free of insects therefore the allegation was deemed UNSUBSTANTIATED.

Staff withheld resident's money- Based on records reviewed, interviews with Staff, Residents and Reporting Party. The resident facilities handbook states that residents in care have the opportunity to get access to P&I funds every morning at 9am. Residents in interviewed stated that they are allowed access to their P&I funds at that time. LPA Lund reviewed Resident (R1) P&I funds from 8/30/2025 through 12/1/2025 showing that R1 was withdrawing money on a daily basis.

Based on records reviewed, interviews with Staff, Residents and Reporting Party the information provided, it was unclear if staff withheld resident's money therefore the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. Exit interview was conducted with and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2