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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700185
Report Date: 02/04/2026
Date Signed: 02/04/2026 05:26:36 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
10/15/2025 and conducted by Evaluator Noel Wolf Petersen
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251015124111
FACILITY NAME:CUPINO HOMEFACILITY NUMBER:
342700185
ADMINISTRATOR:MONICA BUTAYFACILITY TYPE:
735
ADDRESS:8636 LILYPAD LANETELEPHONE:
(916) 509-9450
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:4CENSUS: 4DATE:
02/04/2026
UNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:monica butayTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff falsify facility records
Staff allowed clients in care to leave the facility without proper supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility to conduct a complaint investigation into the above allegations. LPA met with administrator monica butay and explained the purpose of the visit.
Interviewed 3 clients and 3 staff. Per administrator, s1 is an on call staff, s2 left more than 2 years ago and everyone else is a permanent employee of this facility, nobody other than s1 is sharing hours at another facility. Per record review, s1 and s2 are both on the gaurdian roster, s1 is on the current staff schedule. S2 may have been used as an on-call staff in the past 4 months. Per record review of the Staff files, S1 and S2 both have up to date, trainings, health screenings, first aid training from 2025. Clients are all reporting that they are not left alone, Staff are all indicating they understand the policy regarding awol and minimum staffing ratios, and how to call out if necessary. One client is expressing that it is unfair that there are so many staff, when other clients at her day program only have 2 or 3 staff.
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, therefore the allegation is unsubstantiated. A copy of the report was read and given to the staff. Appeal rights were provided. exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026
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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