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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700493
Report Date: 06/05/2025
Date Signed: 06/05/2025 07:32:42 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
02/13/2025 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20250213105533
FACILITY NAME:GREENBACK MANORFACILITY NUMBER:
502700493
ADMINISTRATOR:ABELLA, NICETASFACILITY TYPE:
735
ADDRESS:1604 CARLISLE AVETELEPHONE:
(209) 567-2080
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:6CENSUS: 6DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Administrator Nicetas Abella TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff did not prevent an inappropriate sexual interaction between the clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegation. LPA Lund met with Administrator Nicetas Abella and explained the reason for the visit.

Staff did not prevent an inappropriate sexual interaction between the clients- LPA Lund reviewed facility records, and Modesto Police Department Incident Report- MP25003564. On 2/10/2025 at approximately 1900 hours clients Client’s C1 and C2 went inside C1’s room and may have had intercourse. Modesto PD interviewed C1 at times C1 would change the story and repeat things. Modesto PD stated in the report that It was difficult to clarify certain details and aspects of the incident. Based on statements of all those involved, there is no probable cause that a crime has been committed.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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-20250213105533
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: GREENBACK MANOR
FACILITY NUMBER: 502700493
VISIT DATE: 06/05/2025
NARRATIVE
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Based on facility records reviewed, and Modesto Police Department Incident Report- MP25003564 staff on the information provided, it was unclear if staff did not prevent an inappropriate sexual interaction between the clients, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.

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

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2