502700754-10-25-2023-27-AS-KHOS-CX5N85-20231031101346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700754
Report Date: 10/13/2023
Date Signed: 10/25/2023 09:31:35 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
08/16/2023 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230816130537

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:	10/13/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Norma Borges		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility did not provide resident with transportation
Facility does not meet resident's needs

INVESTIGATION FINDINGS:

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On 10/13/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Renee Campbell arrived unannounced to conduct a complaint visit. LPAs met with Facility Designated Administrator (FDA), Norma Borges and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.
Current census was 3. A brief interview with FDA Borges was conducted.
Allegation: Facility did not provide resident with transportation
It was alleged that the facility did not provide resident with transportation. Based on interviews conducted it was learned that R1 refused to join school activities and asked to go home. R1 called the facility and asked to be picked up where it was learned that the facility did not have time to pick him up and agreed to have someone available at 2:00pm. R1 then called a second facility who share drivers and asked to be picked up but explained that they would not pick the resident up right away. It was stated by facility staff that they have explained the procedures to R1 multiple times in which they did not follow the agreement and asked that they be picked up right away.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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-20230816130537

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: 10/13/2023

NARRATIVE

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LPA could not review facility records as they were not provided to the LPA at the time of this investigation. Based on information gathered, it is unclear if the facility did not provide the resident with transportation.

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.

Allegation: Facility does not meet resident’s needs

It was alleged that the facility does not meet resident’s needs. Based on interviews conducted with facility staff, it was denied that facility does not meet the resident’s needs. It was stated that it is believed that they provide adequate care and supervision to the residents in care and meet their needs. LPA interviewed 1 resident. 1 resident stated that their needs are met at the facility and do not have any issues at this time. 1 resident denied to be interviewed. 2 residents were unable to be interviewed based on their medical conditions. LPA could not review facility records as they were not provided to the LPA at the time of this investigation. Based on the information gathered, it is unclear if the facility does not meet the resident’s needs.

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.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC9099 (FAS) - (06/04)

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