502700367-10-30-2025-27-AS-LRIS-DN4MAT-20251104082654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700367
Report Date: 10/30/2025
Date Signed: 10/30/2025 11:23:06 AM

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
07/03/2025 and conducted by Evaluator Ellen Lindstrom

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250703143958

FACILITY NAME:	DALE COMMONS		FACILITY NUMBER:	502700367
ADMINISTRATOR:	POTTER, LARRY		FACILITY TYPE:	740
ADDRESS:	3900 DALE RD		TELEPHONE:	(209) 526-2053
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	110	CENSUS: 83	DATE:	10/30/2025
		UNANNOUNCED	TIME BEGAN:	09:59 AM
MET WITH:	Morgan Ware, Operations Specialist		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff does not ensure residents call service lights are answered in a timely manner.

Licensee does not provide sufficient staffing resulting in residents being left in soiled clothing for extended periods of time.

INVESTIGATION FINDINGS:

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On 10/30/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom made an unannounced visit to the facility to deliver findings on this complaint. The LPA met with the Operations Specialist and explained the purpose of the visit.

Allegation: Staff does not ensure residents call service lights are answered in a timely manner.

LPA Lindstrom reviewed the call button log for the week of July 1 – July 7, 2025. This log contained 2,871 calls. LPA Lindstrom conducted an in-depth analysis of a subset of this data. Of the 347 consecutive calls that were analyzed, staff responded to 285 calls in less than six minutes, 47 calls in six to ten minutes, and 15 calls in eleven plus minutes. Staff responded to call buttons in ten minutes or less 95.68% of the time, and staff responded to call buttons in five minutes or less 86.45% of the time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Ellen Lindstrom
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025

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-20250703143958

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: DALE COMMONS	FACILITY NUMBER: 502700367
	VISIT DATE: 10/30/2025

NARRATIVE

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Based on a record review, the above allegation is unsubstantiated. 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. As a result of this investigation, no deficiencies were cited. The facility was in compliance with California Code of Regulations (CCR), Title 22, Division 6. An exit interview was conducted and copy of this report was provided to the Operations Specialist.

Allegation: Licensee does not provide sufficient staffing resulting in residents being left in soiled clothing for extended periods of time

LPA Lindstrom conducted staff interviews. Three staff (S1, S2, and S4) stated that there were no issues with providing incontinence care.

LPA Lindstrom conducted three resident interviews. R1 stated that they did not experience inadequate incontinence care due to insufficient staffing or for any reason. R2 stated that they required a two-person assist, and that sometimes when a staff member calls out on the NOC shift, there is a delayed response to their call button. R2 is on a diuretic and sometimes urinates immediately after pressing the call button for assistance to go to the toilet because of the medication. LPA Lindstrom reviewed the call button response log and determined that over a two-day period (July 1- 2, 2025), staff responded to fifteen of R2’s twenty call buttons in five minutes or less, and nineteen of R2’s twenty call buttons in ten minutes or less. R3 stated that staff responded to their call buttons in a timely manner and provided adequate incontinence care. R3 stated that care staff do a great job.

Based on interviews and record review, the above allegation is unsubstantiated. 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. As a result of this investigation, no deficiencies were cited. The facility was in compliance with California Code of Regulations (CCR), Title 22, Division 6. An exit interview was conducted and copy of this report was provided to the Operations Specialist.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Ellen Lindstrom
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025

LIC9099 (FAS) - (06/04)

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