507005675-12-2-2025-27-AS-LRIS-DP3QT9-20251205112647

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507005675
Report Date: 12/02/2025
Date Signed: 12/02/2025 10:23:11 AM

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
11/20/2025 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20251120133942

FACILITY NAME:	SHERWOOD FOREST MANOR 4		FACILITY NUMBER:	507005675
ADMINISTRATOR:	QUINCY BELTRAN		FACILITY TYPE:	735
ADDRESS:	3404 GLENCREST CT		TELEPHONE:	(209) 857-8399
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	6	CENSUS: 5	DATE:	12/02/2025
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Quincy Beltran		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff refused to return personal items to client in care
Staff did not allow client in care to have access to their clothing items

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 12/2/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA was met by Facility Designated Administrator (FDA), Quincy Beltran and explained the purpose of the visit. There was one other staff member present, Anabel Contreras.
Current census was 5. 3 out 5 residents were out at their respective day programs at this time.
A brief interview with FDA Beltran was conducted.

Allegation: Staff refused to return personal items to client in care.
It was alleged that staff refused to return personal items to client in care. During the course of this investigation, LPA Pascua conducted interviews. Based on interviews conducted with 4 staff members, it was denied that staff refused to return any personal items to a client in care. It was stated by all 4 staff members that staff ensure that all resident belongings are given to the residents and are not taken unless asked by the resident.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

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 2

Control Number 27-AS-20251120133942

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: SHERWOOD FOREST MANOR 4	FACILITY NUMBER: 507005675
	VISIT DATE: 12/02/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

An interview with a client was conducted, it was denied that staff refused to return their personal item. Based on the interviews conducted, there was not sufficient to prove that staff refused to return personal items to clients in care.

Allegation: Staff did not allow client in care to have access to their clothing items
It was alleged that staff did not allow client in care to have access to their clothing items. During the course of this investigation, LPA Pascua conducted interviews. Based on interviews conducted with 4 staff members, it was denied that staff refused that they did not allow client to have access to their clothing items. It was stated by all 4 staff members that staff ensure that all resident clothing is in their respective rooms and is accessible to the residents in care. In addition, an interview with a client was conducted and it was denied that they did not have access to their clothing items. In addition, a tour of the facility was conducted, this LPA did not observe any other clothing items outside of their respective bedroom. In addition, this LPA was able to open and close the closet and drawers freely which contained resident belongings and clothing. Based on information gathered, there is not sufficient evidence to prove that the staff did not allow client in care to have access to their clothing items.

As a result of this investigation, this Department found the allegation 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.

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: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2