507003601-2-28-2024-27-AS-LRIS-D3425H-20240305160535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507003601
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:45:29 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
09/21/2023 and conducted by Evaluator Maja Jensen

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230921092607

FACILITY NAME:	LIDIA'S BLESSED HOME		FACILITY NUMBER:	507003601
ADMINISTRATOR:	HIRISCAU, LIDIA		FACILITY TYPE:	740
ADDRESS:	3209 HUMMINGBIRD LANE		TELEPHONE:	(209) 575-3604
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	6	CENSUS: 5	DATE:	02/28/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Lidia Hiriscau		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff is financially abusing resident

INVESTIGATION FINDINGS:

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On 10/28/24 a meeting was held via Microsoft Teams to deliver findings related to the above listed allegation. Present in the meeting were Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Lisa Rios, Licensing Program Analyst (LPA) Maja Jensen and Licensee Lidia Hiriscau.

During the course of the investigation, the Department conducted interviews the Licensee, Resident 1 (R1) , the responsible parties for resident 2 (R2), the responsible party for resident 3 (R3) and the original reporting party. The Department also reviewed a letter from R1, R1's bank statements, canceled check copies, R1's admission agreement, facility register of residents, facility personnel records, emails from the Licensee to the Department and a Power of Attorney designation document executed on 9/23/23.

During the course of the interviews conducted R1 stated they are not being financially abused or coerced in anyway.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230921092607

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: LIDIA'S BLESSED HOME	FACILITY NUMBER: 507003601
	VISIT DATE: 02/28/2024

NARRATIVE

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The responsible parties for R2 and R3 also stated there was no financial abuse occurring at the facility. The Licensee stated R1 asked her to be R1's Power of Attorney and she complied with the request but that none of R1's funds have ever been misappropriated.

Based on the review of the records and interviews conducted the allegation "Facility staff is financially abusing resident" is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

A separate case management is being conducted to address deficiencies in the area of safeguards for cash, personal property and valuables.

An exit interview was conducted and a copy of this report was provided by email for electronic signature.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

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