<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701149
Report Date: 01/08/2025
Date Signed: 01/08/2025 10:39:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/08/2024 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20241008151646
FACILITY NAME:CENTRAL VALLEY ADULT CARE, LLCFACILITY NUMBER:
502701149
ADMINISTRATOR:ORAHAM, JOHNFACILITY TYPE:
775
ADDRESS:1208 FLOYD AVE BLDG ATELEPHONE:
(847) 708-5175
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:90CENSUS: 37DATE:
01/08/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Administrator John OrahamTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek medical care for clients in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegation. LPA Lund met with Administrator John Oraham and explained the reason for the visit. Census: 37

Staff did not seek medical care for clients in care - LPA Lund reviewed facility records, Traffic Collision Report, interviews with staff, reporting party, witnesses and received declarations (LIC855) forms from staff. On 9/30/2024 according to Traffic Collision Report the day program van was involved in a car accident with minor vehicle damage to both vehicles. Modesto Police Department was on seen of the accident who did a Traffic Collision Report. The report states that 1 person was injured in the accident witch was a staff member from the day program, the report doesn’t state that any clients were injured at the time of the accident.

Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
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-20241008151646
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CENTRAL VALLEY ADULT CARE, LLC
FACILITY NUMBER: 502701149
VISIT DATE: 01/08/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Lund interviewed staff, reporting party and witnesses who stated that none of the clients in the accident seek medical care (Emergency room or ambulance) immediately after the accident. Day Program Director John Nisan was notified of the accident went to accident immediately along with the two staff that were involved in the accident verified that the clients involved in the accident didn’t need urgent care at the time of the accident. The van was able to be driven back to the day program along with clients and responsible parties were notified of the accident when they got back to the day program. Interviews with witnesses have stated that no clients went to emergency room immediately after accident.

Based on reviewed facility records, Traffic Collision Report, interviews with staff, reporting party, witnesses and received declarations (LIC855) forms from staff, on the information provided, it was unclear if staff did not seek medical care for clients in care, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2