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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700754
Report Date: 12/15/2022
Date Signed: 12/16/2022 09:16:47 AM

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
11/01/2022 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20221101090527
FACILITY NAME:DREAM CAREFACILITY NUMBER:
502700754
ADMINISTRATOR:HAWES, JULIANFACILITY TYPE:
735
ADDRESS:2004 KRUGER DRIVETELEPHONE:
(209) 661-4666
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:4CENSUS: 4DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Julian HawesTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Facility staff are not in ratio
INVESTIGATION FINDINGS:
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On 12/15/2022 at 11:00am, Licensing Program Analysts (LPAs) Arielle Pascua and Jason Lund arrived unannounced to this facility to conclude the investigation of the above allegations. LPA Pascua and Lund met with Facility Designated Representative, Ednita Gardenhire and explained the purpose of this visit. It was asked at this time to call the Facility Designated Administrator to let them know that CCL was present at this time. The purpose of this visit was to deliver complaint findings for the allegation above.
Allegation: Facility staff are not in ratio
An interview with the Facility Designated Administrator was conducted and it was learned that the facility tries to keep a 2:4 staffing ratio at all times of the day. LPA Pascua also reviewed facility documents, it was determined that the facility’s staff schedule has been consistently operating with a 2:4 ratio between the hours between 12:00am-7:00am and 3:4-5:4 ratio between the hours between 8:00am-11:00pm and able to meet the resident’s needs. On 11/03/2022, LPA Pascua observed 4 staff members present at the facility. On 12/01/2022, LPA observed 3 staff members present at the facility. LPA is unable to prove or disprove if the allegation occurred.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
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-20221101090527
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: 12/15/2022
NARRATIVE
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As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.
There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the Facility Designated Administrator,Julian Hawes.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2