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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700754
Report Date: 06/01/2023
Date Signed: 06/14/2023 12:02:01 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
01/17/2023 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230117150312
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: DATE:
06/01/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Andrea Rush TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Administrator is not fulfilling administrative duties
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived unannounced to this facility to conduct a complaint visit. LPAs were greeted by staff member, Andrea Rush and explained the purpose of the visit. LPAs asked that SM Rush contact the Facility Designated Administrator (FDA) at this time to inform them that CCL was present. LPA Pascua spoke to FDA Julian Hawes and it was learned that he was unable to come to the facility at this time and could continue the visit with SM Andrea Rush. The purpose of this visit was to delivery complaint findings for the allegations above.
Current census was 4. A tour of the facility and a brief interview with SM Rush were conducted
Allegation: Administrator is not fulfilling administrative duties.
It was alleged that the Administrator is not fulfilling administrative duties. During the course of the investigation, LPA conducted 4 staff and 4 resident interviews and reviewed facility records. 4 out 4 staff members stated that they have seen the adminstrator at the facility fulfilling administrative duties. 4 out 4 staff state that they believe that the administrator is able to fulfill administrative work at the facility. 4 out 4 staff deny that the administrator is not filfulling their duties at the facility. 2 out 4 residents state that they have seen the administrator during the day is helping around the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
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 2
Control Number 27-AS-20230117150312
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: 06/01/2023
NARRATIVE
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2 out 4 residents state that the administrator is available to them when they need him. 2 out 4 residents were unable to complete their interviews due to medical reasons. LPA reviewed the facilities current facility roster and it states that the Administrator is on-call on weekends and was available between the hours of 8:00am-5:00pm on weekdays. It is unclear that the administrator is not fulfilling administrative duties.

Based on information provided through interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported.

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 via email. An electronic email read receipt confirms receiving these documents.

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

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2