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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701271
Report Date: 12/11/2025
Date Signed: 12/11/2025 11:46:50 AM

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
10/31/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251031173035
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:
12/11/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nicolette TaylorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff are not properly logging resident's medication
INVESTIGATION FINDINGS:
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On 12/11/2025, Licensing Program Analysts (LPAs) Arielle Pascua and Jason Lund arrived unannounced to this facility to deliver complaint findings. LPAs were greeted by Facility Designated Representative (FDR), Nicolette Taylor and explained the purpose of the visit. The purpose of the visit was deliver complaint findings for the allegations above. One other staff member was present, Paul Fletcher.

Current census was 3. A brief interview with FDA Taylor was conducted.

It was alleged that the staff are not properly logging residents medication. During the course of this investigation, this LPA conducted interviews and reviewed facility records. Based on interviews conducted, it was denied by 3 staff members that medications are being properly logged. It was explained by 3 staff members that the facility holds and retains Medication Administration that is held on a computer to administer medication.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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-20251031173035
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: 12/11/2025
NARRATIVE
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In response, LPA Pascua reviewed Medication Administration records for 3 residents were conducted. All Medication Administration records indicate that medication was administered in a timely manner and were logged at the time of administration for am, evening and pm medication. Based on the information gathered, there is not sufficient evidence to show that staff are not properly logging resident’s medication.

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.
An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2