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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507004929
Report Date: 04/14/2026
Date Signed: 04/14/2026 03:59:08 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
01/20/2026 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260120140759
FACILITY NAME:DUTCHOLLOW SUITES IFACILITY NUMBER:
507004929
ADMINISTRATOR:CANDIDO, CECILIAFACILITY TYPE:
740
ADDRESS:4112 LAURANT COURTTELEPHONE:
(209) 521-0566
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:4CENSUS: 4DATE:
04/14/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cecilia CandidoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not store medications locked and inaccessible to residents in care.
Staff were asleep and left residents without supervision while in care.
Staff did not ensure that hazardous objects were inaccessible to residents in care.
Staff do not ensure that the facility is kept in a clean condition.
INVESTIGATION FINDINGS:
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On 04/14/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings for the allegation above. LPA Pascua met with Facility Designated Representative (FDR), Cecilia Candido and explained the purpose of the visit.

Current census was 4. A brief interview with FDA Candido was conducted.
Allegation: Staff did not store medications locked and inaccessible to residents in care.
It was alleged that staff did not store medications locked and inaccessible to residents in care. During the course of this investigation, the department conducted interviews, reviewed facility records, and reviewed video recordings. Interviews with two staff members indicated that medications are kept locked and inaccessible to residents in care. However, recordings obtained from approximately 01/13/2026 contradict this claim. In the footage, a responsible party is seen arriving at the facility and observing medications left on the kitchen table.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
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 7
Control Number 27-AS-20260120140759
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: DUTCHOLLOW SUITES I
FACILITY NUMBER: 507004929
VISIT DATE: 04/14/2026
NARRATIVE
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Further review shows approximately 15 medication bottles and a bubble pack placed on a wooden chair near the facility cabinets, making them accessible to residents. Although staff reported that medications were secured, the recording also shows that no staff members were awake at the time. Based on the information gathered, the facility staff did not store medications locked and inaccessible to the residents in care.

Allegation: Staff were asleep and left residents without supervision while in care.

It was alleged that staff were asleep and left residents without supervision while in care. During the course of this investigation, the department conducted interviews and reviewed video recordings. Interviews with two staff members indicated that staff were not asleep and that residents were not left without supervision. However, statements from outside parties reported that a responsible party arrived at the facility and was able to gain entry with assistance from a resident. Upon entry, the responsible party observed S1 seated in the middle recliner with their eyes closed.

Recordings obtained from approximately 01/13/2026 further contradict staff statements. The video shows one resident in a recliner, one resident in a wheelchair, and two residents in a separate room. Additionally, upon entry into the living area, a male staff member wearing a dark green sweater and light-colored jeans is observed with his legs propped up and eyes closed, appearing unaware that a recording was being made at that time.

Based on the information gathered, the staff were asleep and left residents without supervision while in care.

Allegation: Staff did not ensure that hazardous objects were inaccessible to residents in care.

It was alleged that staff did not ensure that hazardous objects were inaccessible to residents in care. During the course of this investigation, the department conducted interviews and reviewed video recordings. Based on interviews conducted, it was denied by 2 staff members that they did not ensure that hazardous objects were inaccessible to residents in care. It was stated that residents were unable to access the kitchen without staff knowledge however, further interviews revealed that around 01/13/2026, the kitchen was accessible to residents. During a family visit, items such as knives were observed, and the stove was on. Additionally, the staff member present at that time appeared to be asleep. A review of video footage confirmed that the kitchen was accessible to the visiting family member and showed a large silver knife on a cutting board with two pieces of zucchini beside it, along with the gas stove turned on.Based on the information gathered, the staff did not ensure that hazardous objects were inaccessible to residents in care.

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

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 27-AS-20260120140759
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: DUTCHOLLOW SUITES I
FACILITY NUMBER: 507004929
VISIT DATE: 04/14/2026
NARRATIVE
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Allegation: Staff do not ensure that the facility is kept in a clean condition.

It was alleged that staff do not ensure that the facility is kept in a clean condition. During the course of this investigation, the department conducted observations during their visit and conducted interviews. Interviews with two staff members indicated that the facility is maintained in a clean condition. Staff also stated that at the time of LPA Pascua’s visit on 01/16/2026, they were in the process of cleaning. However, interviews with responsible and outside parties reported observing significant clutter throughout the facility.

During a subsequent tour conducted by LPA Pascua on 01/26/2026, which included the living areas, dining areas, bedrooms, and backyard, the facility was observed to have a heavy level of clutter across multiple areas, including the kitchen, living spaces, and bedrooms. In the kitchen, there were signs of inadequate sanitation, including cluttered countertops, food items left out, and a sink area with visible debris and buildup. The refrigerator appeared overfilled and disorganized, with food items stored without clear separation. Common living areas contained personal items and laundry that limited available space. The outdoor area also showed disorganization, with various items stored haphazardly and containers holding standing water. Based on the information gathered, the staff do not ensure that the facility is maintained in a clean condition.

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.

An immediate civil penalty of $500 was issued for Section 1569.312(e) for facility staff sleeping while supervising the residents.

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: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
01/20/2026 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260120140759

FACILITY NAME:DUTCHOLLOW SUITES IFACILITY NUMBER:
507004929
ADMINISTRATOR:CANDIDO, CECILIAFACILITY TYPE:
740
ADDRESS:4112 LAURANT COURTTELEPHONE:
(209) 521-0566
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:4CENSUS: 3DATE:
04/14/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cecilia CandidoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Resident developed a rash due to staff neglect while in care.
INVESTIGATION FINDINGS:
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On 04/14/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings for the allegation above. LPA Pascua met with Facility Designated Representative (FDR), Cecilia Candido and explained the purpose of the visit.

Current census was 3. A brief interview with FDA Candido was conducted.

It was alleged that a resident developed a rash due to staff neglect while in care. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted, it was stated that the resident had a rash sometime around 01/26/2026, the facility notified R1’s responsible party of a rash that they identified during a shower.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 27-AS-20260120140759
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: DUTCHOLLOW SUITES I
FACILITY NUMBER: 507004929
VISIT DATE: 04/14/2026
NARRATIVE
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Contact with the residents doctor was also conducted. Further review of the resident’s appraisal was conducted which did not identify a rash on the residents body however interviews were conducted which could not identify when the rash started and revealed contradicting information. Based on the information, there is not sufficient evidence to prove that the resident developed a rash due to staff neglect.
As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.
There were no deficiencies observed or cited at this time.
An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 27-AS-20260120140759
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: DUTCHOLLOW SUITES I
FACILITY NUMBER: 507004929
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/14/2026
Section Cited
CCR
87465(h)(2)
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(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
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Medications were observed to be locked and made inaccessible at the time of this visit.
Facility Administrator stated that a review of the section will be conducted. A statement of correction, along with proof of staff training from an outside vendor for no less than (1) hour in duration,
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This is not met as evidenced by: Based on interview and record review, the licensee did not ensure that medication was locked and made inaccessible to the residents in care. This poses an immediate health, safety, and personal rights risks to persons in care.
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for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date. Information submitted must include attendees, trainers, and information discussed.
Type B
05/14/2026
Section Cited
CCR
87309(a)
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(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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Facility Administrator stated that a review of the section will be conducted. A statement of correction, along with proof of staff training from an outside vendor for no less than (1) hour in duration, for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date. Information submitted must include attendees, trainers, and information discussed.
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This is not met as evidenced by: Based on observations, the licensee did not ensure that knives and hazardous materials were locked and made inaccessible to the residents in care. This poses an immediate health, safety, and personal rights risk 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: 04/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 27-AS-20260120140759
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: DUTCHOLLOW SUITES I
FACILITY NUMBER: 507004929
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/15/2026
Section Cited
HSC
1569.312(e)
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Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being.
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Facility Administrator stated that a review of the section will be conducted. A statement of correction, along with proof of staff training from an outside vendor for no less than (1) hour in duration, for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date. Information submitted must include attendees, trainers, and information discussed.
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This is not met as evidenced by: Based on interview and record review, this Licensee did not ensure that S1 supervised the residents in care. It was stated through interviews that S1 was witnessed to be sleeping at the time of a family visit which was corroborated through a video recording. This poses an immediate health, safety, and personal rights risks to persons in care.
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Type B
05/14/2026
Section Cited
CCR
87303(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Facility Administrator stated that a review of the section will be conducted. A statement of correction, along with proof of cleaning and cleaning schedule will sent to the LPA by POC date.
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This is not met as evidenced by: Based on observations, the licensee did not ensure that the facility was in a clean manner. It was observed that that facility had clutter across multiple areas, including the kitchen, living spaces, and bedrooms. 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: 04/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 7