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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701271
Report Date: 10/20/2025
Date Signed: 10/20/2025 11:07:42 AM

Substantiated


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
10/08/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251008133423
FACILITY NAME:DREAM CARE #4FACILITY NUMBER:
502701271
ADMINISTRATOR:JAMES, IBONIFACILITY TYPE:
735
ADDRESS:2604 VERRANO AVETELEPHONE:
(510) 875-4894
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:4CENSUS: 3DATE:
10/20/2025
UNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Nicolette Taylor TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility staff verbally assaulted resident in care
Facility staff physically assaulted resident in care
INVESTIGATION FINDINGS:
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On 10/20/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA was greeted by Staff Member (SM), Carlette Sharpe and explained the purpose of the visit. SM Sharpe notified the Facility Designated Representative (FDR), Nicolette Taylor that CCL was present. SM Sharpe notified LPA Pascua that FDR Taylor would be arriving shortly. LPA Pascua asked SM Taylor to contact the Facility Designated Administrator (FDA), Iboni James to inform them that CCL was present. It was learned that FDA James was unable to be reached during the time of this visit. There was one other staff member present, Carlette Sharpe.

Current census was 3. A brief interview with SM Taylor was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
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 3
Control Number 27-AS-20251008133423
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: DREAM CARE #4
FACILITY NUMBER: 502701271
VISIT DATE: 10/20/2025
NARRATIVE
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Allegation: Facility staff verbally assaulted resident in care.

It was alleged that facility staff verbally assaulted resident in care. Based on interviews conducted, it was determined that on 10/08/2025, Resident 1 (R1) was found in the backyard of the facility early in the morning, sleeping with a guest. Staff member 2 (S2) approached R1 and woke them up. When R1 asked if they were in trouble, S2 reassured them that they were not and allowed them to continue sleeping. Between approximately 7:00 a.m. and 7:30 a.m., both Staff Member 1 (S1) and S2 approached R1 and the guest again, instructing them to leave the premises. According to further interviews, S1 became verbally aggressive when R1 stated they had been told they could remain. S1 responded by saying, “Nah, you can get the f*** out of my house too because you are not following my rules.” Additionally, it was reported that S1 continued to threaten R1 in the front yard, stating they would have their partner come and physically harm the resident if they did not leave. Witnesses indicated that shortly after this incident, bystanders intervened, and S1 left the premises in their vehicle. Based on the interviews conducted, facility staff verbally assaulted resident in care.

Allegation: Facility staff physically assaulted resident in care.

It was alleged that facility staff physically assaulted resident in care. Based on interviews conducted, it was determined that on 10/08/2025, Resident 1 (R1) was found in the facility's backyard early in the morning, where they were approached by Staff 1 (S1) and Staff 2 (S2). Witnesses stated that during the encounter, S1 became verbally aggressive toward R1 and their guest. In response, R1 stood up holding their phone. At that point, S1 struck R1’s wrist and knocked the phone from their hand. Witnesses confirmed observing S1 hit R1’s wrist during the incident. Based on interviews conducted, facility staff physically assaulted resident in care.

Based on the information gathered, it was concluded that facility staff engaged in physical assault against a resident under their care.

As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

An exit interview was conducted and a copy of this report and appeals rights was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20251008133423
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: DREAM CARE #4
FACILITY NUMBER: 502701271
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/21/2025
Section Cited
CCR
80072(a)(1)
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(a)Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1)To be accorded dignity in his/her personal relationships with staff and other persons.
This is not met as evidenced by: Based on interviews conducted,
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The facility shall undergo training from a vendorized trainer for no less than (1) hour in duration on the topic of Resident Rights and Maintaining Personal Rights.
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the licensee did not ensure that R1 was accorded with dignity with their personal relationship with staff and other persons. It was learned that facility verbally assaulted and yelled at a resident in care. This poses an immediate health, safety and personal rights risks to persons in care.
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A statement of correction and acknowledgment, along with documented proof of scheduled training topics, dates, and times will be completed and submitted into CCL by the due date.
Type A
10/21/2025
Section Cited
CCR
80072(a)(3)
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(a)Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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The facility shall undergo training from a vendorized trainer for no less than (1) hour in duration on the topic of Resident Rights and Maintaining Personal Rights.
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Based on interviews conducted, this facility was found to be deficient as evidenced by the investigation findings that the facility staff physically assaulted residents in care. This posed an immediate threat to the Health, Safety, and Personal Rights risks to persons in care.
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A statement of correction and acknowledgment, along with documented proof of scheduled training topics, dates, and times will be completed and submitted into CCL by the due date.
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: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3