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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701475
Report Date: 12/11/2025
Date Signed: 12/11/2025 01:37:19 PM

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
10/22/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251022081702
FACILITY NAME:DREAM CARE #2FACILITY NUMBER:
502701475
ADMINISTRATOR:MARTINEZ, DEBRAFACILITY TYPE:
735
ADDRESS:408 FAIRWAY DRIVETELEPHONE:
(510) 875-4894
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:4CENSUS: 3DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Nadia Falconer TIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Licensee accepted a resident with a higher level of care
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 Staff Member (SM), Nadia Falconer and explained the purpose of the visit.
Current census was 3.

It was alleged that the licensee accepted a resident with a higher level of care. Based on interviews conducted, it was determined that in October 2025 the facility accepted a resident under “emergency reasons” without following the required admissions procedures. A review of the facility’s Plan of Operation indicates that prospective residents must be eligible for Valley Mountain Regional Center Level 4I services.
During an interview, the licensee stated that the resident arrived at the facility unexpectedly and was allowed to stay at the facility while they worked on getting paperwork established with the Regional Center.
Substantiated
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 3
Control Number 27-AS-20251022081702
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 #2
FACILITY NUMBER: 502701475
VISIT DATE: 12/11/2025
NARRATIVE
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Additional information revealed that the resident was not an appropriate fit for the facility due to medical needs requiring a restricted health care plan, which the facility’s program design is not authorized to provide. Therefore, this placement was not appropriate for the resident.
Based on the information gathered, the licensee accepted a resident with a higher level of care.
As a result of this investigation, the department found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.
The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.
An exit interview was conducted and a copy of this report and appeals rights 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 3
Control Number 27-AS-20251022081702
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 #2
FACILITY NUMBER: 502701475
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/09/2026
Section Cited
CCR
85068.4(a)(4)
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(4) Persons who require more care and supervision than is provided by the facility.
This is not met as evidenced by: Based on interviews conducted, the Licensee accepted a resident who required more care and supervision than is provided by the facility.
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Facility staff stated that they will contact the administrator for a plan of correction.
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 This poses a potential health, safety, and personal rights risks 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: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3