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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 11:47:29 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
11/01/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251101191007
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:
10:41 AM
MET WITH:Nicolette TaylorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility staff are not meeting residents needs
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.

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

It was alleged that facility staff are not meeting residents needs. During the course of this investigation, LPA reviewed recordings and conducted interviews. Based on the review of video recordings, LPA Pascua could hear an individual screaming and shouting outside the facility; however, the footage did not clearly show whether staff were present or assisting the resident at that time. Interviews were conducted with three staff members, all of whom denied being unable to meet residents’ needs or mitigate behaviors.

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-20251101191007
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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Two residents were also interviewed and both stated that staff are able to assist them. Additionally, interviews with two Valley Mountain Regional Center Service Coordinators were conducted, and both reported that facility staff are meeting residents’ needs and expressed no concerns. Based on the information gathered, there is not sufficient evidence to prove that the facility staff are not meeting residents needs.

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