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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700233
Report Date: 06/09/2026
Date Signed: 06/09/2026 02:19:45 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
04/28/2026 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260428161737
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: 78DATE:
06/09/2026
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Ariel ThomasTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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9
Staff do not allow resident to possess personal belonging
Staff did not provide a safe environment for resident
INVESTIGATION FINDINGS:
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On 06/09/2026, Licensing Program Analysts (LPAs) Arielle Pascua and Sulma Lopez arrived unannounced to this facility to deliver complaint findings for the allegations above. LPAs met with Facility Designated Administrator (FDA), Ariel Thomas and explained the purpose of the visit.
Current census was 78. A brief interview with FDA Thomas was conducted.

Allegation: Staff do not allow resident to possess personal belongings.
It was alleged that staff do not allow resident to possess personal belongings. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted, it was determined that the facility confiscated a resident's cell phone due to the resident's failure to comply with established house rules. Further interviews revealed that the resident acknowledged retaining the cell phone beyond the agreed-upon time and using it in a manner that violated facility guidelines. The cell phone agreement and house rules were provided to both the resident and their conservator upon admission, and both agreed to these terms at that time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
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-20260428161737
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: 06/09/2026
NARRATIVE
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Additionally, interviews were conducted with three other residents, all of whom reported that they are permitted to retain personal belongings, including their cell phones. A review of the facility's house rules and cell phone agreement further confirmed that residents are allowed to keep their personal belongings, subject to compliance with established facility policies and agreements.

Based on the information gathered, there is not sufficient evidence to prove that the staff do not allow resident to possess personal belongings.

Allegation: Staff do not provide a safe environment for resident

It was alleged that staff do not provide a safe environment for resident. During the course of this investigation, the department conducted interviews with facility staff and residents. Based on interviews conducted with facility staff, it was denied that any incident occurred between Resident 1 (R1) and Resident 2 (R2). Staff reported that R2 tends to keep to themselves and has not exhibited any issues with residents or staff within the facility. Staff further stated that R1 has approached R2 on occasion, alleging that R2 had harmed them; however, no such incidents have been observed or witnessed by facility staff.An interview with R2 was conducted, during which R2 denied having conversations or interactions with R1. Additionally, an interview with R1 was conducted, and R1 provided conflicting statements regarding the alleged incidents involving R2.

Furthermore, interviews were conducted with five residents. All five residents denied that staff fail to provide a safe environment for residents in care. Based on the information gathered, the department cannot prove that staff do not provide a safe environment for the residents.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2