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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700754
Report Date: 02/09/2023
Date Signed: 02/10/2023 09:01:18 AM

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
01/20/2023 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230120163415
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:
02/09/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Julian HawesTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is operating against fire clearance
INVESTIGATION FINDINGS:
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On 02/09/2023 at 2:00PM, Licensing Program Manager (LPM), Stephen Richardson and Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility uannounced to conduct a complaint visit. LPM and LPA met with Facility Designated Administrator (FDA), Julian Hawes and explained the purpose of this visit. The purpose of this visit was to deliver complaint findings for the allegations above. Current Cenus was 4. A brief interview with FDA Hawes was conducted.
It was alleged that the facility is operating against the fire clearance. During the course of this investigation, facility documents were reviewed and interviews were conducted. On 01/27/.2023, LPA Pascua conducted an initial complaint visit a tour of the facility was conducted. It was found that a staff member was in the garage. This staff member was interviewed during this visit and it was learned that they have been living at this facility, in the garage, since 01/15/2023 when they were hired. LPA Pascua reviewed the facility sketch and fire clearance forms and it was observed that the garage was not cleared as staff room. Additionally, the facility sketch does not designate any staff rooms. Based on facility records, the facility also does not have an operational plan for live-in staff.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
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 3
Control Number 27-AS-20230120163415
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: 02/09/2023
NARRATIVE
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Therefore, the facility is operating against the fire clearance.

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. A civil penalty was issued in the amount of $500 for violation of 80020(a).

Exit interview was conduct, a copy of this report along with appeals rights were emailed to the Facility Designated Administrator.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20230120163415
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: 02/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/10/2023
Section Cited
CCR
80020(a)
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80020(a) Fire Clearance. All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by:
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Licensee will obtain a proper fire clearance to allow live-in staff. Licensee shall provide a copy of their fire clearance along with new plan of operation that states a plan for live-in staff.
Civil Penalities are assessed today in the amount of $500.
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Based on observation, record review, and interviews conducted the Licensee did not obtained a proper fire clearance to obtain live-in satff. This is a immediate health,safety, and personal risks to the persons in care.
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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: 02/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3