502700754-1-27-2023-27-AS-KHOS-CPPN53-20230307090851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700754
Report Date: 01/27/2023
Date Signed: 01/27/2023 06:21:29 PM

Substantiated

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
02/03/2022 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220203104747

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: 4	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Julian Hawes		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility does not have adequate food supplies
Facility bathrooms are not maintained clean and sanitary
Facility has rotten food in the backyard

INVESTIGATION FINDINGS:

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On 1/27/2023 at 10:00am, Licensing Program Analysts (LPAs) Arielle Pascua and Jason Lund arrived at this facility unannounced for a complaint visit. LPAs were greeted Facility Designated Administrator, Julian Hawes and explained the purpose of the visit. The purpose of the visit was to deliver complaint findings for the allegations above. There were 3 other staff members present at the facility, Bea Esquivel-Valdez, Alma Moyamoy, and Geraldo Vazquez.

Current census was 4. 1 out of 4 residents were out at their respective day program at this time.
It was alleged that the facility bathrooms are not maintained clean and sanitary. During the investigation, LPAs observed 1 of 2 restrooms to be in disrepair. The restroom that was present in Resident1 (R1)’s bedroom contained dried urine stains on the restroom floor with additional urine stains on the walls surrounding the toilet. There was the presence of a strong urine odor upon entry into this restroom. Based on observation, the facility did not maintain clean and sanitary bathrooms, therefore the allegation was SUBSTANTIATED.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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 6

Control Number 27-AS-20220203104747

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: 01/27/2023

NARRATIVE

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It was alleged that the facility did not have adequate food supplies. Based on interviews and the information that was gathered throughout the course of this investigation, this facility was deficient as evidenced that there was not a sufficient supply of 2-day perishable and 7-day nonperishable food quantities maintained at all times. During the initial visit on 2/9/2022, LPA observed sufficient food supply to meet regulatory standards. However, it was learned through interviews with witnesses that this facility operated on a set food allowance for the month and once that money was spent, facility staff had to reach out to the facility Administrator for additional funds. It was learned that, often times, facility staff had to purchase food items to float the facility until the end of the month at their own expense. Without staff purchasing food, the staff would not have been able to provide meals to clients. This was an ongoing issue since communication was poor with the facility Licensee/Administrator and additional funds were often delayed, so facility staff had to take action. Based on the information provided through interviews, this allegation was SUBSTANTIATED.

It was alleged that the facility had rotten food in the backyard. Based on observations and information that was gathered throughout the course of this investigation, this facility was deficient as evidenced that there was a fruit bearing tree present in the backyard. The LPA observed several large fruits had fallen from the tree onto the ground. Upon further review, it was observed that the fruits had started to decay and rot losing all color and shape. Based on observation of the LPA, the facility did have rotten food in the backyard, therefore this allegation was SUBSTANTIATED.

Based on observations, review of records and information gathered through interviews, the above allegations were SUBSTANIATED meaning that there was a preponderance of evidence to prove that the allegations occurred as alleged.

The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An immediate civil penalty is was assessed for a violation of Section 80087(a) for the visit today on, 1/27/2022. The facility was cited on the violation above on 12/15/2022. Licensee was informed that the civil penalty will continue to accrue $100 per day per violation until the deficiency is corrected.

An exit interview was conducted with facility representative and a copy of this report was provided along with appeal rights.

At this time the Facility Designated Administrator asked for all documentation to this visit to be sent to his email and did not sign any paperwork at the times of the visit.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 27-AS-20220203104747

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/27/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/28/2023 Section Cited CCR 85076(d)(1)	1 2 3 4 5 6 7	Food Service – 85076(d)(1) The licensee shall meet the following food supply and storage requirements: (1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.	1 2 3 4 5 6 7	Facility Administrator will provide a statement of correction to ensure that the food supply requirements will be met. Facility administrator will send in the statement of correction to the LPA by the POC date on 01/28/2023 at the LPAs email at arielle.pascua@dss.ca.gov
	8 9 10 11 12 13 14	Based on interviews and the information that was gathered throughout the course of this investigation, this facility was deficient as evidenced that there was not a sufficient supply of 2-day perishable and 7-day nonperishable food quantities maintained at all times. It was learned that this facility operated on a set food allowance for the month and once the money was spent facility staff had to reach out to the facility Administrator for additional funds. It was learned that, often times, facility staff had to purchase food items to float the facility until the end of the month at their own expense. This was an ongoing issue since communication was poor with the facility Administrator and additional funds were often delayed so facility staff had to take action. This posed an immediate threat to the Health, Safety, and Personal Rights of the residents in care.	8 9 10 11 12 13 14
Type A 01/28/2023 Section Cited CCR 80088(e)(3)	1 2 3 4 5 6 7	Furniture, Fixtures, Equipement, and Supplies- 80088(e)(3) All toilets, hand washing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences shall be provided in facilities accommodating physically handicapped clients who need such items	1 2 3 4 5 6 7	Facility Administrator will provide a plan to ensure that cleaning will be met. A cleaning schedule shall be put in place to ensure that the facility is maintained in a safe and sanitary operating condition. Facility administrator will send the statement of correction to the LPA by the POC date on 01/28/2023
	8 9 10 11 12 13 14	Based on interviews and the information that was gathered throughout the course of this investigation, this facility was deficient as evidenced that the restroom that was present in R1’s bedroom was locked and made inaccessible to facility residents. The restroom that was present in R1’s bedroom contained dried urine stains on the restroom floor with additional urine stains on the walls surrounding the toilet. There was the presence of a strong urine odor upon entry into this restroom. This posed an immediate threat to the Health, Safety, and Personal Rights of the residents in care.	8 9 10 11 12 13 14	to the LPAs email at arielle.pascua@dss.ca.gov

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 27-AS-20220203104747

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/27/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/10/2023 Section Cited CCR 80087(a)	1 2 3 4 5 6 7	Buildings and Grounds-80087(a) The facility shall be clean, safe, and sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. Based on observations, and information that was gathered throughout the course of this investigation, this facility was deficient as evidenced that there was a fruit bearing tree present in the backyard	1 2 3 4 5 6 7	The facility administrator stated that the facility will provide a plan in place to ensure that the the facility grounds will be free of rotting fruit. A statement of correction will be provided to the LPA's email at arielle.pascua@dss.ca.gov by COB on the POC date on 02/10/2023.
	8 9 10 11 12 13 14	It was observed that several large fruits had fallen from the tree onto the ground. Upon further review, it was observed that the fruits had started to decay and rot losing all color and shape. This posed a potential threat to the Health, Safety, and Personal Rights of the residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 6

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
02/03/2022 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220203104747

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: 4	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Julian Hawes		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Clients don’t have access to funds

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 27-AS-20220203104747

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: 01/27/2023

NARRATIVE

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It was alleged that the clients don't have access to funds. Based on interviews conducted and the information gathers, it was learned that the clients were allowed access to their personal funds. Clients at the facility were able to ask appointed staff members present to access their funds. It was also stated that staff did not have any issues accessing client funds at this time. In addition, P&I ledgers were reviewed. It was observed that all resident P&I ledgers had sufficient documentation in which receipts and the proper signatures were obtained. Based on the information provided it is unclear if the clients did not have access to funds.

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 emailed to the Facility Designated Administrator,Julian Hawes.

At this time the Facility Designated Administrator asked for all documentation to this visit to be sent to his email and did not sign any paperwork at the times of the visit

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

Page: 6 of 6