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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701198
Report Date: 01/21/2026
Date Signed: 01/22/2026 09:01:42 AM

Substantiated


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
01/15/2026 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260115122805
FACILITY NAME:BRENDA'S PLACEFACILITY NUMBER:
392701198
ADMINISTRATOR:MCCARTHY, BRENDAFACILITY TYPE:
740
ADDRESS:408 VALDAPENA COURTTELEPHONE:
(209) 403-2944
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY:6CENSUS: 6DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Daisy FloresTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff are not following the plan of operation for the facility

INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 01/21/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility house manager Daisy Flores. A brief interview was conducted with the facility house manager at this time.
This LPA requested that she also go ahead and contact the facility designated Administrator, Brenda McCarthy, to inform her that CCL was present at this time for a complaint visit.
Current census was 6 residents.
The purpose of this visit was to inform this facility, and it's representative, that a complaint had been filed with the following above allegation.
Based on observation, it was learned that resident, R1, had been moved to the living room of this facility. It was observed that R1 was in R1's own bed and utilized this area as R1's own quarters at this time. It was observed that R1 was positioned in R1's bed facing out towards the dining area of this facility at this time.
Based on interviews conducted during the course of this investigation, it was learned that R1 was admitted and originally occupied a bedroom designated for resident use located at the east end of this facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
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 5
Control Number 27-AS-20260115122805
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: BRENDA'S PLACE
FACILITY NUMBER: 392701198
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/22/2026
Section Cited
CCR
87307(a)(2)(B)
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Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. No room commonly used for other purposes shall be used as a sleeping
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The facility representative stated that the resident currently residing in the living room will immediately be moved back into their assigned bedroom.
A statement of correction, along with photos of the cleared living room area where the resident used to occupy, will be completed
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room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building.
This facility was found to be deficient as observed by the placement of a resident into the living room to serve as their bedroom. This posed an immediate risk to the Health, Safety, and Personal Rights of all residents in care.
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and submitted into CCL by the due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/15/2026 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260115122805

FACILITY NAME:BRENDA'S PLACEFACILITY NUMBER:
392701198
ADMINISTRATOR:MCCARTHY, BRENDAFACILITY TYPE:
740
ADDRESS:408 VALDAPENA COURTTELEPHONE:
(209) 403-2944
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY:6CENSUS: 6DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Daisy FloresTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Staff are operating beyond the terms and conditions of the license
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 01/21/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility house manager Daisy Flores. A brief interview was conducted with the facility house manager at this time.
This LPA requested that she also go ahead and contact the facility designated Administrator, Brenda McCarthy, to inform her that CCL was present at this time for a complaint visit.
Current census was 6 residents.
The purpose of this visit was to inform this facility, and it's representative, that a complaint had been filed with the following above allegation.
Based on a review of the facility license, it was observed that this facility was licensed to be able to retain and accept up to (6) residents who were deemed to be non ambulatory at any given time. It was observed that there were only (6) residents in care at this time.
This facility was also able to provide care and supervision to (1) bedridden resident as well as retain residents deemed to be under the care of hospice at any given time.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20260115122805
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: BRENDA'S PLACE
FACILITY NUMBER: 392701198
VISIT DATE: 01/21/2026
NARRATIVE
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This agency has investigated the complaint allegation(s). This agency has found that the complaint was UNFOUNDED, meaning that the allegation(s) were false, could not have happened and/or was without a reasonable basis. This agency has therefore dismissed the complaint.

There were no deficiencies observed or cited during today’s complaint visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20260115122805
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: BRENDA'S PLACE
FACILITY NUMBER: 392701198
VISIT DATE: 01/21/2026
NARRATIVE
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It was learned that R1 was eventually moved out of R1's room so that R1 could be present amongst the other residents and facility staff since R1 was unable to independently move around freely without any assistance from R1's bedroom.
It was learned that this was conducted so that R1 would not be isolated due to the physical limitations for R1 at this time.
Based on interviews, it was learned that R1 had been occupying this living room area as R1's bedroom for about a month now.
It was learned that care and supervision was provided to R1, in terms of ADLs, within this living room area. It was learned that facility staff would put up dividers to shield R1 for privacy when this was being performed.
This living room has never been cleared to be able to have a resident occupy it as a resident bedroom at any point in time.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

A civil penalty in the amount of $500 was assessed for this violation on the following LIC 421 IM.

Appeal rights were printed and a copy was left with the facility designated House Manager at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5