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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507001468
Report Date: 06/26/2026
Date Signed: 07/03/2026 01:06:06 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
04/29/2026 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260429104442
FACILITY NAME:SIERRA SALEM CHRISTIAN HOMES INC.FACILITY NUMBER:
507001468
ADMINISTRATOR:DEBORAH MENSONIDESFACILITY TYPE:
735
ADDRESS:1805 WOODLAND AVENUETELEPHONE:
(209) 544-9300
CITY:MODESTOSTATE: CAZIP CODE:
95358
CAPACITY:6CENSUS: 6DATE:
06/26/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Regina Smith and Tina MeinersTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff do not ensure residents P&I records are maintained
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 05/01/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated representative, Regina Smith, who was interviewed at this time.
This LPA requested that the facility representative go ahead and contact the facility designated Administrator to inform them that CCL was present at this time.
Current census was 6 residents.
The purpose of this visit was to deliver the findings from this investigation to this facility, and its representative, in regards to the above allegation at this time.
Based on a review of the forms and documents gathered during the course of this investigation, it was learned that documentation was not properly maintained for facility residents. It was learned that signatures were not properly attained upon withdrawal of resident P& I funds from the resident themselves.
Based on interviews conducted during the course of this investigation, admissions were made that proper documentation was not being maintained at all times when dispensing funds to the facility residents.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
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 3
Control Number 27-AS-20260429104442
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: SIERRA SALEM CHRISTIAN HOMES INC.
FACILITY NUMBER: 507001468
VISIT DATE: 06/26/2026
NARRATIVE
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As a result of this investigation, this LPA found the allegation 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 observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

Appeal rights were printed and a copy was left with the facility designated Administrator at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260429104442
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: SIERRA SALEM CHRISTIAN HOMES INC.
FACILITY NUMBER: 507001468
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2026
Section Cited
CCR
80026(h)(1)(A)
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Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following:
(1) Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting,
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The facility designated Administrator stated that all records for P&I funds for the facility residents will be reviewed to make sure that proper documentation is maintained at all times. A statement of correction, along with proof of updated staff training for no less than (1) hour in duration, will be completed and submitted
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with columns for income, disbursements and balance, for each client. Supporting receipts for purchases shall be filed in chronological order.
(A)Receipts for cash provided to any client from his/her account(s) shall include the client's full signature or mark, or authorized representative's full signature or mark, and a statement acknowledging receipt of the amount and date received, as follows:
This facility was found to be deficient as evidenced by the lack of proper documentation with resident signatures and/or initials when funds were requested and withdrawn which posed an immediate threat the health, safety, and personal rights to all residents in care.
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into CCL by the due date for review by this LPA.
Proof of training will involve the topic of training, name of trainer, duration of training, and a list of all attendees.
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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: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3