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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701450
Report Date: 08/21/2025
Date Signed: 08/22/2025 03:29:59 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
05/23/2025 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20250523150712
FACILITY NAME:CASA DE MODESTOFACILITY NUMBER:
502701450
ADMINISTRATOR:ISSAKHANI, STEPHANYFACILITY TYPE:
740
ADDRESS:1745 ELDENA WAYTELEPHONE:
(925) 594-1122
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:160CENSUS: 90DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Program Coordinator Anita Mishra TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff do not prevent residents from using illegal drugs
Staff are not properly cleaning resident bedrooms
Staff do not keep resident rooms free from odor
Licensee does not ensure enough staff are present to meet the needs of residents
Facility staff are leaving residents soiled for an extended period of time
Staff are not properly supervising residents who may be a fall risk
Staff are not dispensing medication as prescribed
Staff are not providing adequate laundry services for residents
Staff are not meeting resident bathing needs
Staff are not providing adequate food service
Staff do not intervene between resident verbal interactions
Staff blocks exit doors presenting a hazard to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Program Coordinator Anita Mishra and explained the reason for the visit. Census: 90
Staff do not prevent residents from using illegal drugs - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on facility records reviewed, interviews with staff, and residents in care. LPA Lund has made fourteen unannounced visits to the facility from 2/12/2024 through 8/21/2025 has never observed any residents in care using illegal drugs. Staff interviewed stated that they never observed any residents in care using illegal drugs and if observed would notify management immediately. Residents interviewed stated that they never seen any residents in care using illegal drugs.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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 5
Control Number 27-AS-20250523150712
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: CASA DE MODESTO
FACILITY NUMBER: 502701450
VISIT DATE: 08/21/2025
NARRATIVE
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Based on reviewed facility records, interviews with staff, and residents in care, on the information provided, it was unclear if staff do not prevent residents from using illegal drugs, therefore the allegation was deemed UNSUBSTANTIATED.

Staff are not properly cleaning resident bedrooms - LPA Lund reviewed facility records and observed residents’ rooms, interviewed staff, and residents in care. LPA Lund reviewed housekeeper schedules and housekeepers work at the facility from 6:00 am through 6:30 pm throughout the week. Housekeeper clean memory care rooms daily and assisted side weekly in less needed. LPA Lund observed rooms in memory care and in assisted care to be clean and in compliance. Staff interviewed stated if a resident’s room needs attention either housekeeping or care staff will clean the room. Residents interviewed stated that their rooms are cleaned with the help of staff.

Based on reviewed facility records, interviews with staff and residents in care, on the information provided, it was unclear if staff are not properly cleaning resident bedrooms, therefore the allegation was deemed UNSUBSTANTIATED.

Staff do not keep resident rooms free from odor – LPA Lund reviewed facility records and observed residents’ rooms, interviewed staff, and residents in care. LPA Lund reviewed housekeeper schedules and housekeepers work at the facility from 6:00 am through 6:30 pm throughout the week. Housekeeper clean memory care rooms daily and assisted side weekly in less needed. LPA Lund observed rooms in memory care and in assisted care to be free from odor and in compliance. Staff interviewed stated if a resident’s room needs attention either housekeeping or care staff will clean the room. Residents interviewed stated that their rooms are cleaned with the help of staff.

Based on reviewed facility records, interviews with staff and residents in care, on the information provided, it was unclear if Staff do not keep resident rooms free from odor, therefore the allegation was deemed UNSUBSTANTIATED.

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

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20250523150712
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: CASA DE MODESTO
FACILITY NUMBER: 502701450
VISIT DATE: 08/21/2025
NARRATIVE
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Licensee does not ensure enough staff are present to meet the needs of residents – LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on staff schedules from 3/30/25 through 8/20/25 the revealed staff to be consistently residents in care on duty. LPA Lund interviewed residents in care who stated that their needs are being met. Staff interviewed stated that there is adequate staff to meet the needs of the residents in care.

Based on facility records reviewed, interviews with staff, and residents in care, on the information provided, it was unclear if licensee does not ensure enough staff are present to meet the needs of residents, therefore the allegation was deemed UNSUBSTANTIATED.

Facility staff are leaving residents soiled for an extended period of time- LPA Lund reviewed facility records, interviewed staff and residents in care. Staff are trained to ask residents in care about bathroom checks every two hours in less residents in care need to be checked sooner. Staff interviewed stated they have sufficient time to make sure that residents in care are changed. Residents interviewed stated that staff ask about bathroom needs and help when needed.

Based on reviewed facility records, interviews with staff, and residents in care, on the information provided, it was unclear if facility staff are leaving residents soiled for an extended period of time, therefore the allegation was deemed UNSUBSTANTIATED.

Staff are not properly supervising residents who may be a fall risk- LPA Lund reviewed facility records, interviewed staff, and residents in care. Staff have had an in-service training (Preventing falls in facilities) dated 4/16/2025. The facility does two-hour bedroom checks and sooner if needed for all residents in care. Staff interviewed stated they have been trained in how to help prevent residents in care from falling. Residents interviewed stated that staff are great about reminders about using the restroom and if they needed help with getting up.

Based on reviewed facility records, interviews staff and residents in care, on the information provided, it was unclear if staff are not properly supervising residents who may be a fall risk, therefore the allegation was deemed UNSUBSTANTIATED.

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

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20250523150712
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: CASA DE MODESTO
FACILITY NUMBER: 502701450
VISIT DATE: 08/21/2025
NARRATIVE
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Staff are not dispensing medication as prescribed- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on reviewed facility paperwork each Med Tech takes ten courses from Advanced Healthcare studies on how to work with medications for the facility. Each staff member must have this training before working with residents medications. Staff interviewed stated that they have procedures on how to work with residents regarding medications. Residents interviewed stated that they take the medications that staff provide to them.

Based on facility records reviewed, interviews with staff, and residents in care, on the information provided, it was unclear if staff are not dispensing medication as prescribed, therefore the allegation was deemed UNSUBSTANTIATED.

Staff are not providing adequate laundry services for residents- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on reviewed facility paperwork each resident in care has laundry days. Staff interviewed stated if a resident in care needs something washed before their laundry day staff will wash it. Residents interviewed stated that their laundry is done by staff and has had no problems.

Based on facility records reviewed, interviews with staff, and residents in care, on the information provided, it was unclear if staff are not providing adequate laundry services for residents, therefore the allegation was deemed UNSUBSTANTIATED.

Staff are not meeting resident bathing needs- Based on facility records review, interviews with staff, and residents in care. Facility records indicate that residents did get their scheduled showers if they need the help of staff, if a resident is independent they can take showers when they want to. Each resident who needs assistance has a scheduled shower day that staff will assist them with. Staff interviewed state that residents in the care get showers twice a week or as necessary. Residents interviewed, state they did get showers twice a week or as necessary.

Based on facility records review, interviews with staff and residents in care, the information provided; it was unclear if staff are not meeting resident bathing needs, therefore the allegation was deemed UNSUBSTANTIATED.

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

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20250523150712
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: CASA DE MODESTO
FACILITY NUMBER: 502701450
VISIT DATE: 08/21/2025
NARRATIVE
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Staff are not providing adequate food service- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on review of the facility menu March 3, 2025, through May 17, 2025. LPA’s Lund observation of 2- day supply of perishable food and 7- day supply of non-perishable food is in compliance. Residents interviewed stated that they the facility is providing adequate food for them. Staff interviewed stated that residents have not complained about the food being served at the facility.

Based on records reviewed, interviews with staff, and residents in care, on the information provided, it was unclear if facility staff are not providing adequate food service, therefore the allegation was deemed UNSUBSTANTIATED.

Staff do not intervene between resident verbal interactions- LPA Lund reviewed facility records, interviewed staff, and residents in care. Staff have had, in-service training (Challenging Behaviors and dementia) along with the initial 6 hour and 40 minutes with Care Academy training on how to work with the residents in care. Staff interviewed stated that when residents are have a disagreement they intervene with asking them a question and if that doesn’t work they notify management immediately to help. Residents interviewed stated that staff are great and help them when they need it.

Based on reviewed facility records, interviews with staff, and residents in care, on the information provided, it was unclear if staff do not intervene between resident verbal interactions, therefore the allegation was deemed UNSUBSTANTIATED.

Staff blocks exit doors presenting a hazard to residents- LPA Lund reviewed facility records and interviewed staff. Based on facility records reviewed and interviews with staff. LPA Lund has made fourteen unannounced visits to the facility from 2/12/2024 through 8/21/2025 has never observed any exit doors being blocked. Staff interviewed stated that they never observed exit doors being blocked.

Based on reviewed facility records and interviews with staff, on the information provided, it was unclear if staff blocks exit doors presenting a hazard to residents-, 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: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5