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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700664
Report Date: 01/09/2026
Date Signed: 01/11/2026 10:34:14 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
09/18/2025 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20250918112215
FACILITY NAME:HLH-2 CARE HOME INCFACILITY NUMBER:
502700664
ADMINISTRATOR:CAMI J AZEVEDOFACILITY TYPE:
735
ADDRESS:1721 SILVAIRE DRIVETELEPHONE:
(209) 244-3898
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:4CENSUS: 4DATE:
01/09/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Cami AzevedoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff yell at residents

Facility is operating out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund met Administrator Cami Azevedo and explained the reason for the visit. Census: 4

Staff yell at residents- Based on records reviewed, interviews with clients, reporting party, and staff. LPA Lund review facility Required Reporting of Dependent Adult Abuse for staff & 40 hours of 14 training courses for staff orientation. LPA Lund interviewed staff who stated they have never seen any staff yell at any clients in care, if they had they would notify management immediately. LPA Lund interviewed clients in care who stated no staff have yelled at them.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
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-20250918112215
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: HLH-2 CARE HOME INC
FACILITY NUMBER: 502700664
VISIT DATE: 01/09/2026
NARRATIVE
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Based on records review, interviews with clients, reporting party, and staff the information provided, it was unclear if staff yell at residents, therefore the allegation was deemed UNSUBSTANTIATED.

Facility is operating out of ratio- Based on records reviewed, interviews with client, reporting party, and staff. LPA Lund reviewed facility schedules from 9/1/2025 through 9/30/2025. LPA Lund interviewed staff who stated they have enough staff to meet the needs of clients in care. LPA Lund interviewed clients in care who stated that staff are always here to meet the needs of clients.

Based on records review, interviews with client, reporting party, and staff the information provided, it was unclear if facility is operating out of ratio therefore the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. Exit interview was conducted with and report left.

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

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2