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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701290
Report Date: 06/18/2024
Date Signed: 06/18/2024 01:49:29 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
04/21/2024 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20240421235232
FACILITY NAME:CARVER CARE RESIDENTIALFACILITY NUMBER:
502701290
ADMINISTRATOR:CALLA, PATRICIAFACILITY TYPE:
735
ADDRESS:1009 CARVER ROADTELEPHONE:
(209) 204-5157
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:70CENSUS: 40DATE:
06/18/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Ashley GudinoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not provide menstrual products to a client while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund met with Administrator Ashley Gudino and explained the reason for the visit. Census:40
Staff did not provide menstrual products to a client while in care- Based on records reviewed, interviews with clients, reporting party, and staff. LPA Lund reviewed facility records which states that the facility bought feminine products on 4/16/2024 when the facility observed that they were out. The facility offered the products to Client (C1) who wanted to continue wearing the product C1 was wearing when the facility ran out feminine products. LPA Lund interviewed Staff who stated that they have observed sufficient feminine products and when the facility ran out the facility immediately went out and got more supplies. Clients interviewed stated that the facility has always had products when needed.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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-20240421235232
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: CARVER CARE RESIDENTIAL
FACILITY NUMBER: 502701290
VISIT DATE: 06/18/2024
NARRATIVE
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Based on records review, interviews with clients, reporting party, and staff the information provided, it was unclear if staff did not provide menstrual products to a client while in care based on behavior therefore the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. Exit interview was conducted with and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2