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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507004929
Report Date: 06/26/2026
Date Signed: 07/13/2026 11:11:36 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
02/17/2026 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260217144649
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:
06/26/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cecilia CandidoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Illegal eviction

Staff retaliated against a resident due to a complaint being filed against facility

Staff did not assist a resident in ambulating to the restroom

Staff did not allow residents to participate in activities of their own choosing

Staff yelled at a resident
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 02/25/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Cecilia Candido, who was interviewed at this time.
Current census was 4 residents.
The purpose of this visit was to deliver the findings of this investigation to this facility, and its representative, at this time.
Based on a review of the forms and documents gathered during the course of this investigation, it was learned that R1 had been a resident with this Licensee dating back to a prior licensed care facility in the Merced area. It was learned that this facility in the Merced area was closed and R1 was then relocated to this facility here in the Modesto area. It was observed that the only LIC 602 completed was performed and signed by the attending physician on 06/20/2025. There were no other LIC 602s completed or updated at this time. A records request from this LPA in regards to the LIC 602 for R1 only produced this single document that was completed on 06/20/2025.
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 5
Control Number 27-AS-20260217144649
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: 06/26/2026
NARRATIVE
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In addition, a review of the forms and documents gathered during the course of this investigation produced a Preplacement Appraisal Information (LIC 603) that was signed and dated on 12/05/2025 which was almost a month after the initial admission of R1 into this facility on 11/15/2025.
It was learned that this initial appraisal cited excessive wandering within the confines of this facility and poor boundary limits by R1. It also cited cursing and threatening by R1 unto others in care with history of manipulation by R1 to gain an advantage.
It was learned that the Appraisal/Needs and Services Plan, completed on 01/16/2026, was signed by R1 and facility designated Administrator Cecelia Candido but no date was recognized or noted on the LIC 625 at that time. This document stressed the same issues as indicated on the LIC 603 which was completed a month earlier.
It was observed that these were the only versions that were present without any updated versions to present any changes to the needs and increased levels of behavior that would warrant a higher level of care for R1. It was learned that R1's level of care and needs were the same as when she was living in the licensed care facility in Merced and remained the same upon relocation to this Modesto care facility. All supporting documents (LIC 602, LIC 603, LIC 625) were completed around the admission date to this facility but were never updated or changed to reflect any needs to elevate the level of care for R1.
It was learned that this was the main reason for grounds of eviction served unto R1 since it was alleged that R1 had become a danger to self and to others in the facility yet there weren't any updated forms and documents to note these changes since admission to this facility to prove any new threats to self or others in care.
Based on statements attained during the course of this investigation, it was learned that facility staff have spoken to residents in care in a manner that violated their personal rights. It was learned that the tone and manner in which it was directed unto the residents was not professional but rather dismissive.
It was learned that facility staff were not available when residents were in need of assistance so proper care and supervision was not being afforded to the residents in care. It was learned that facility staff dismissed a resident's call for assistance in going to the restroom determining that their request was not valid at that time.
It was learned that facility residents were unable to move around to either change the television channels or manipulate the remote to change the stations in order to watch something that interested them. Instead, it was learned that facility residents were subject to watch what was already present on the television at that time and were not allowed to change the channels as they saw fit.
Based on a review of the forms and documents gathered during the course of this investigation, it was learned there was a complaint filed in January of 2026 which involved R1. Shortly thereafter the eviction
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 5
Citations on this Visit Report are Under Appeal!

Control Number 27-AS-20260217144649
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: 06/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
06/27/2026
Section Cited
CCR
87219(a)(1)
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Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include:
Socialization to promote or enhance personal relationships. Activities may
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The facility designated Administrator stated that all facility staff will undergo training, for no less than (1) hour in duration, on the topic of proper resident activities from a vendorized entity set forth on the CCLD website.
A statement of correction, along with proof
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include, but are not limited, to:
This facility was found to be deficient as evidenced by the lack of activities that were being offered and lack of involvement for the facility residents made by the facility staff. This posed an immediate threat to the Health, Safety, and Personal Rights to all residents in care.
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of updated training, will be completed and submitted into CCLD for review by this LPA by the due date.
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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.
SUPERVISOR'S 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: 5 of 5
Citations on this Visit Report are Under Appeal!

Control Number 27-AS-20260217144649
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: 06/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
06/27/2026
Section Cited
CCR
87224(d)
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The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons.
This facility was found to be deficient as evidenced by serving an eviction notice which
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The facility designated Administrator stated that all facility staff will undergo training, for no less than (1) hour in duration, on the topic of proper eviction procedures from a vendorized entity set forth on the CCLD website.
A statement of correction, along with proof
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did not have supporting information to note that a considerable change in behavior had occurred requring a higher level of care causing concern for harm to the resident and other residents in care. This posed an immediate threat to the health, safety, and personal rights to all residents in care.
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of updated training, will be completed and submitted into CCL for review by this LPA by the due date.
Under Appeal
Type A
06/27/2026
Section Cited
CCR
87468.2(a)(3)
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In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:
To be encouraged and assisted in exercising their rights as citizens and as residents of the
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The facility designated Administrator stated that all facility staff will undergo training, for no less than (2) hours in duration, on the topic of Personal Rights from a vendorized entity set forth on the CCLD website.
A statement of correction, along with
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facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights.
This facility was found to be deficient as evidenced by the execution of an eviction notice to a resident and their responsible party after a complaint was filed. This posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.
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proof of updated training, will be completed and submitted into CCL for review by this LPA by the due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S 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 5
Control Number 27-AS-20260217144649
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: 06/26/2026
NARRATIVE
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notice was served to R1 on 02/13/2026 which was only a few weeks after the filing of the complaint in January of 2026 with allegations surrounding R1. It was learned that the reason for eviction did not have any supporting evidence to signify why the eviction was being served. There was not any established grounds to note a change in condition nor support that a higher level of care was needed since follow up was not sought to address any of these concerns at that time.
As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegations were 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: 4 of 5