502700754-5-31-2022-27-AS-KHOS-CMLR3S-20221230114025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700754
Report Date: 05/19/2022
Date Signed: 05/31/2022 03:39:03 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2022 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220311092857

FACILITY NAME:	DREAM CARE		FACILITY NUMBER:	502700754
ADMINISTRATOR:	HAWES, JULIAN		FACILITY TYPE:	735
ADDRESS:	2004 KRUGER DRIVE		TELEPHONE:	(209) 661-4666
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	4	CENSUS: 3	DATE:	05/19/2022
		UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Ednita Gardenhire		TIME COMPLETED:	12:09 PM

ALLEGATION(S):

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Facility is not allowing fully vaccinated visitors into the facility
Staff uses inappropriate form of punishment
Facility is in disrepair
Staff yells at resident

INVESTIGATION FINDINGS:

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Allegation: Facility is not allowing fully vaccinated visitors into the facility

Based on records reviewed and interviews conducted it was confirmed that the facility was informing staff that visitation rules that had expired on 2/7/2022 from the Ca. Department of Public Health (CDPH) were used as the standard for a family attempting to visit a residents. On/or about 3/10/2022, it was alleged that a family member attempted to visit a resident at the facility. The facility allegedly informed that party that they were unable to come into the facility based on outdated information. LPA was able to review visitor's log sheets that confirmed that visit were allowed on multiple days after the 7th of Feburary 2022, this was the date for the expiration of the standard set by the CDPH.

Continued****

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2022

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-20220311092857

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: DREAM CARE	FACILITY NUMBER: 502700754
	VISIT DATE: 05/19/2022

NARRATIVE

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LPA reviewed text messages with no dates to staff at the facility that questions why on a morning a family was not allowed to visit or come into the facility. The information in the text is not supported by a date. LPA was able to validate dates of confirmed visits for this family, on the facilities' visitor logs those dates were 2/14/22, 2/22/22, 3/4/22, 3/13/22 and 3/21/22.

Allegation: Staff uses inappropriate form of punishment

Based on interviews conducted and records reviewed, LPA was unable to collaborate the day or time of the alleged event. All staff denied witnessing or being part of punishment of any resident at anytime. All staff stated that they use the behavior intervention plans to address or ignore the maladaptive behaviors of each resident. They also stated that there is a zero tolerance for any form of punishment or restraint.

Allegation: Facility is in disrepair

Based on records reviewed and interviews conducted the staff confirmed that the shower in the main bedroom was broken at one time and the water was turned off to fix the leak which was causing water damage to the floor board. The problem was fixed with in three days and the residents were able to use the bathroom while the problem was being fixed. All interviewed stated that the residents used the shower in the second bathroom for the time period when the shower was being repaired.

Allegation: Staff yells at resident

Based on interviews conducted, LPA was unable to collaborate the day or time of the alleged event. All staff denied witnessing or hearing any resident being yelled at anytime. All staff stated that they use the behavior intervention plans to address or ignore the maladaptive behaviors of each resident. They also stated that there is a zero tolerance for any form of personal right violation, punishment or restraint.

As a result of this investigation, this LPA found the allegation to be UNSUBSTANTIATED - A finding that a complaint is 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 did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

LIC9099 (FAS) - (06/04)

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