502701078-7-14-2023-27-AS-LKIG-CTXQSS-20230721122602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502701078
Report Date: 06/29/2023
Date Signed: 07/14/2023 01:35:41 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
02/03/2022 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220203101706

FACILITY NAME:	DREAM CARE #2		FACILITY NUMBER:	502701078
ADMINISTRATOR:	HAWES, JULIAN		FACILITY TYPE:	735
ADDRESS:	408 FAIRWAY DRIVE		TELEPHONE:	(510) 320-2800
CITY:	MODESTO	STATE: CA	ZIP CODE:	95351
CAPACITY:	4	CENSUS: 4	DATE:	06/29/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Norma Borgus		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility does not provide clients transportation.
Facility staff is mismanaging clients' funds.
Clients don't have access to their funds.
Facility does not have adequate food supplies.
Administrator is not at the facility for a sufficient amount of time.
Facility does not provide a safe environment for clients in care.
Facility did not obtain complete medical records.

INVESTIGATION FINDINGS:

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On 06/26/2023, Licensing Program Analysts (LPAs) Arielle Pascua, Christina Valerio and Arvin Villanueva arrived unannounced to this facility to conduct a complaint visit. LPAs were greeted by staff member (SM) Norma Borges and explained the purpose of the visit. LPA Pascua asked that SM Burgos contact the Facility Desingated Administrator (FDA) to inform them that CCL was present at this time. LPAs were informed that the FDA, Julian Hawes, was unable to come to the facility at this time due to other meetings. LPAs continued the visit with SM Borges. The purpose of this visit is to deliver complaint findings for the allegations above.

Allegation: Facility does not provide clients transportation.
It was alleged that the facility does not provide clients transportation. Throughout the investigation LPA conducted staff and resident interviews and reviewed facility files. Based on staff interviews it was learned that most residents are picked up for their respective day programs by the program bus. Staff stated that when program bus is not available then there is someone available who can take the resident to day program when needed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

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 5

Control Number 27-AS-20220203101706

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 #2	FACILITY NUMBER: 502701078
	VISIT DATE: 06/29/2023

NARRATIVE

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Staff also state that most residents like to stay at the facility but when they do have outings or appointments, they coordinate with the other home to get transportation. Staff state that some residents also have home visits in which family will take them. An interview with 4 residents were conducted. Resident 1 (R1) was conducted denied that the facility did not provide them transportation. R1 stated that the day program will pick them up and drop them off at the facility. R1 denies any issues obtaining transportation for any appointments or outings. 3 out of 4 residents denied an interview. A review of the facilities plan of operation was conducted. The facilities plan of operation states that the facility will provide or have provisions for residents medical and dental appointments, community activities, emergencies, and to and from school or day programs. A review of the all residents Individual Program Plan was conducted and confirmed that the facility would be providing transportation for all resident services. Based on the information gathered, it is unclear at this time if the facility did not provide client transportation.
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.

Allegation: Facility staff is mismanaging client funds.

It was alleged that the facility staff is mismanaging client funds. Throughout the investigation the LPA conducted staff and resident interviews and reviewed facility files. Based on staff interviews, it was denied that facility staff was mismanaging client funds. It was stated that only a handful of individuals have access to residents funds and are audited by the facility on a weekly basis. An interview with 4 residents were conducted. R1 stated that they know they have money and can take it at any time. R1 denied having any issues with their funds. 3 out 4 residents denied any interview. LPA Pascua reviewed P&I documents from January 2022-March 2022. It was observed that all components of the documentation did not show that the facility staff was mismanaging client funds. Based on the information gather, it is unclear at this time if the facility staff is mismanaging client 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.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 27-AS-20220203101706

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 #2	FACILITY NUMBER: 502701078
	VISIT DATE: 06/29/2023

NARRATIVE

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Allegation: Clients do not have access to their funds.

It was alleged that clients do not have access to their funds. Throughout the investigation LPA Pascua conducted staff and resident interviews and reviewed facility files. Based on interviews, it was denied by staff that clients do not have access to their funds. It was reported that staff provide clients their funds when asked. An interview with An interview with 4 residents were conducted. R1 stated that they know they have money and can take it at any time. R1 denied having any issues with their funds. 3 out 4 residents denied any interview. Based on the information gathered, it is unclear if the clients do not have access to their funds.

There were no deficiencies observed or cited at this time.

Allegation: Facility does not have adequate food supplies

It was alleged that staff do not ensure that facility has a sufficient amount of food for residents in care. During the course of this investigation, the LPA toured facility and conducted staff and resident interviews. Based on observation, the LPA toured the facility to ensure that there was a sufficient amount of food available based on Title 22 regulations. LPA observed that there was a sufficient amount of 2 day perishable food supply and 7 day non-perishable food supply for the amount of residents during the visits conducted on 06/01/2022 and 06/15/2022. An interview staff was conducted. Staff stated that the facility does weekly grocery trips in order to supplement perishable food supply and bi-weekly grocery trips are conducted to supplement non-perishable food supply. 4 out of 4 resident interviews were conducted. R1 stated that the facility always has food and enjoy the food that is available to them. 3 out 4 residents denied interviews. Based on interviews and LPA observation, it was unclear if the facility does not have adequate food supplies.

There were no deficiencies observed or cited at this time.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 27-AS-20220203101706

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 #2	FACILITY NUMBER: 502701078
	VISIT DATE: 06/29/2023

NARRATIVE

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Allegation: Administrator is not at the facility for a sufficient amount of time

It was alleged that the Administrator is not at the facility for a sufficient amount of time. During the course of the investigation, LPA conducted staff and resident interviews. Based on staff interviews it was stated that the Administrator is there almost every day. Staff report that the administrator goes between two homes and understand that they may be busy and have different obligations. Staff believes that the administrator is at the facility for a sufficient amount of time. An interview with 4 residents were conducted. R1 states that the administrator is there every week to help around the facility. 3 out 4 residents denied to be interviewed. Based on the information gathered, it is unclear if the Administrator is not at the facility for a sufficient amount of time.

There were no deficiencies observed or cited at this time.

Allegation: Facility did not provide a safe environment for clients in care.

It was alleged that the Facility did not provide a safe environment for clients in care. During the course of the investigation, LPA conducted staff and resident interviews. Based on staff interviews it was denied that they do not provide a safe environment for the residents. It was reported that the residents enjoy being at home and are always engaging with each other. An interview with 4 residents were conducted. R1 stated that they think that this is a safe environment for them to live in and deny that they have ever felt that it was not safe. 3 out 4 residents denied to be interviewed. An interview with the Valley Mountain Regional Center Liaison (VMRCL) was conducted. It was reported that there have been no concerns regarding having a safe environment by the resident’s service coordinators. Based on the information gathered, it is unclear the facility did not provide a safe environment for clients in care.

Allegation: Facility did not obtain complete medical records.

It was alleged that the Facility did not obtain complete medical records. During the course of the investigation, LPA conducted interviews and reviewed resident files. Based on interviews conducted, it was learned that prior to the resident's admission to the facility they need to complete a physicans report that is required by the department. In addition, a review of the facilities plan of operation, medical records are to be

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 27-AS-20220203101706

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 #2	FACILITY NUMBER: 502701078
	VISIT DATE: 06/29/2023

NARRATIVE

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requested by the facility prior to admission to ensure a proper pre-admission appraisal. A review of the facilities records were conducted. It was observed that the resident's medical records are complete by the current residents and have been obtained by the facility. Based on the information gathered, it is unclear if the facility did not obtain complete medical records.

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.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

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