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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701474
Report Date: 11/03/2025
Date Signed: 11/03/2025 11:38:34 AM

Substantiated


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
COMPLAINT CONTROL NUMBER: 27-AS-20251101191844
FACILITY NAME:DREAM CARE #1FACILITY NUMBER:
502701474
ADMINISTRATOR:MARTINEZ, DEBRAFACILITY TYPE:
735
ADDRESS:2004 KRUGER DRIVETELEPHONE:
(510) 875-4894
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:4CENSUS: 4DATE:
11/03/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kenroy Anderson TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility does not allow residents from freely exiting the facility
INVESTIGATION FINDINGS:
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On 11/03/2025, Licensing Program Analysts (LPAs), Arielle Pascua and Jason Lund arrived unannounced to this facility to conduct a complaint visit. LPAs was greeted by Staff Member (SM), Carlette Sharpe and explained the purpose of the visit. The purpose of this visit was to inform the facility and its representative that a complaint has been filed against it at this time. There was one other staff member present at the facility, Donald Stewart.
Current census was 4. 2 out 4 were out of the facility at this time. A brief interview with SM Sharpe and SM Stewart were conducted. After several attempts to contact the Facility Administrator, facility staff was unable to reach the administrator at this time. Shortly after, House Manager (HM), Kenroy Anderson arrived at the facility.
It was alleged that the facility restricted residents from freely exiting the premises. During the investigation, it was discovered that modifications had been made to the facility’s front door. These alterations included the installation of a second doorknob with an additional lock. Furthermore, the primary doorknob was fitted with a child-proof cover, preventing residents from easily exiting the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
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 3
Control Number 27-AS-20251101191844
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 #1
FACILITY NUMBER: 502701474
VISIT DATE: 11/03/2025
NARRATIVE
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A photograph received by LPA Pascua on October 31, 2025, confirmed that a black child-proof doorknob cover had been installed at the time of the Regional Center’s visit on Wednesday, October 29, 2025, at 1:45 p.m. During the visit, LPAs Pascua and Lund attempted to open the facility door but were unable to do so without manipulating both the upper and lower doorknobs.

LPA Pascua informed facility staff that this presented a fire hazard, as the door serves as an emergency exit. Staff stated that all residents were capable of opening the door, explaining that the rubber lock had been added for a resident who previously required assistance. However, it was confirmed that this resident no longer resides at the facility.



Based on the information gathered, the facility did not allow residents from freely exiting the facility.

An immediate civil penalty of $500 is being issued during today’s visit for violation of Section 80020(a).

The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit along appeals rights.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20251101191844
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 #1
FACILITY NUMBER: 502701474
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely
Type A
11/04/2025
Section Cited
CCR
80020(a)
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80020(a)
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.
This is not met as evidenced by: Based on observation and interview,
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The facility house manager took off the top off and demonstrated that the door was able to be opened at the time of this visit.
A statement of acknlowledgement and correction will be sent to the LPA by POC date.
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the licensee did not ensure that the fire exit was easily accessible to residents in care. This poses an immediate health,safety, and personal rights to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
LIC9099 (FAS) - (06/04)
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