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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701450
Report Date: 07/13/2026
Date Signed: 07/14/2026 09:18:26 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
02/22/2026 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20260222205300
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: 94DATE:
07/13/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Program Coordinator Anita Mishra TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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9
Staff did not administer medication as prescribed.
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: 94

Staff did not administer medication as prescribed - LPA Lund reviewed facility records, and interviewed staff. Based on records reviewed, and interviews with staff. LPA Lund reviewed Resident (R1’s) medication log from 12/15/2025 through 03/13/2026 which states R1 doesn’t have any medications that need to be crushed. R1 left the facility on 3/13/2026 and was not able to be interviewed. The facility has guidelines for medications that need to crushed for residents in care for MED TECKS.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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-20260222205300
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: 07/13/2026
NARRATIVE
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Based on reviewed facility records and interviews with staff on the information provided, it was unclear if staff did not administer medication as prescribed, 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: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2