507203017-12-22-2021-27-AS-SDOB-CB2T7X-20220126132927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 12/22/2021
Date Signed: 12/22/2021 03:39:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/14/2021 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20210614160222

FACILITY NAME:	MODESTO RESIDENTIAL LIVING CENTER, LLC		FACILITY NUMBER:	507203017
ADMINISTRATOR:	DENNIS MONTEROSSO		FACILITY TYPE:	735
ADDRESS:	1932 EVERGREEN AVE		TELEPHONE:	(209) 530-9300
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	100	CENSUS: 90	DATE:	12/22/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Administrator Steven Bryant		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff injured resident while in care
Staff threatened resident
Staff did not safeguard resident's personal property
Staff withheld resident's funds
Staff did not treat resident with dignity or respect

INVESTIGATION FINDINGS:

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

On 12/22/2021, Licensing Program Analyst (LPA) Jason Lund arrived at the facility unannounced to complete a complaint investigation regarding the above allegations. LPA Lund meet with Administrator Steven Bryant and explained the reason for the visit. Current Census 90

LPA Lund reviewed client (C1) records and facility records. LPA interviewed staff and clients regarding the above allegations.

Based on the investigation through interviews with staff, clients and records review (Unusual Incident/Injury Report dated 11/21/2020 & Doctor’s Medical records), C1 had an incident with staff who tried to counsel C1. C1 tried to make homemade alcohol in the window of C1’s room. Staff who observed the homemade alcohol called for support (Supervisor). The supervisor attempted to counsel C1. C1 would not remove the homemade alcohol and when the supervisor reached for the bottle, C1 jumped and grabbed supervisor. Staff and supervisor than redirected C1 to the bed and the police was called for assistance and police (Modesto Police Department) refused (Does not meet criteria) to take C1. C1 requested to go to the hospital where C1 was examined and discharged the same day back to the facility with no new diagnosis and no apparent injuries. C1was to follow up with C1’s doctor.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

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 4

Control Number 27-AS-20210614160222

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MODESTO RESIDENTIAL LIVING CENTER, LLC	FACILITY NUMBER: 507203017
	VISIT DATE: 12/22/2021

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

Based on interviews and facility records, with staff and clients. C1 stayed at the facility from 1/3/2020 until 12/11/2020. C1 stated that C1 was constantly threatened by Staff while living at the facility. C1 could not recall any pacific dates of the abuse. C1 had many interactions with staff about calling 911 (Modesto Police Department) and other incidents stated on Unusual/Incident/Injury Reports reported to Community Care Licensing (CCL) from the facility. LPA interviewed staff and clients in care at facility. Staff interviewed stated that have not seen any staff threatened or abuse any clients in care and if has seen any abuse, they would report it to management immediately. Clients interviewed in care stated that have not witnessed any staff abuse or threaten any client’s in care at the facility, if had would report to staff immediately.

Through interviews with management, staff, clients and facility records. On 4/22/2019 C1 had 55 items on C1’s client/resident personal property and valuables paperwork. C1 stated that he had items (Books) stolen from C1 but never reported it to staff or management. C1 believed that staff took books from C1’s room. C1 only update his client/resident personal and valuables paperwork one time and that was on 4/22/2019. C1 believed that the books were bought and stolen after that date.

LPA Lund interviewed management regarding client’s property items getting stolen from clients. Management stated when client’s report missing items the facility staff will look for such items and replace items if the items are on client/resident personal and valuables paperwork if not found.

LPA Lund interviewed staff regarding client’s property getting stolen. Staff that were interviewed stated that they would look for client’s property that went missing and if not found they would report it to management who would replace such items if on client’s paperwork.

LPA Lund interviewed clients regarding client’s property getting stolen. Clients interviewed stated that if something was taken from them as long it was on the client/resident personal and valuables paperwork it would be replaced. Staff and management would remind clients if they were to get something new (property) to put it on the paperwork.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20210614160222

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MODESTO RESIDENTIAL LIVING CENTER, LLC	FACILITY NUMBER: 507203017
	VISIT DATE: 12/22/2021

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

LPA Lund could not confirm if C1’s books were taken from staff or clients. C1 never reported any thang missing to management and never updated client/resident personal and valuables paperwork.

Based on interviews with staff and clients and facility records. C1 stated that staff would destroy C1’s ticket’s and take C1’s money. C1 never reported to staff or management that his tickets were destroyed or money was taken from C1.

Clients could only receive money, tickets or both to buy snacks and tobacco from the facility store. If clients received money, they could go to the store to buy what they (Clients) wanted. Tickets from the facility were only good for clients to buy thangs for clients and were not supposed to traded from client to client. Staff could not use the tickets to buy things from the facility store.

Staff interviewed and confirmed that they could not use tickets to buy thangs at the facility store. If clients would help staff with daily activities (take out trash, help with bingo and other duties) at the facility the clients would earn tickets from staff to get snacks from the facility store. Staff interviewed if they seen any staff destroying client’s tickets or take clients’ money, they would report to management immediately.
Clients interviewed stated they could earn extra tickets from staff if they would help with daily activities to get snacks at the facility store. Clients interviewed stated that they could get money or tickets to buy snacks or cigarettes at the facility store and the facility store had better and cheaper snacks then going to the store. Clients interviewed has never seen staff take tickets from clients or take clients money from an client and they had would report it to staff or management.

The investigation conclude that LPA Lund could not confirm if staff or clients took or destroyed C1’s tickets or took C1’s money. The facility didn’t have any records on C1’s tickets getting destroyed or money taken from C1.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20210614160222

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MODESTO RESIDENTIAL LIVING CENTER, LLC	FACILITY NUMBER: 507203017
	VISIT DATE: 12/22/2021

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

Based on interviews with staff and clients, C1 stated that C1 was not treated with dignity or respect. C1 would be on the phone and staff would tell C1 not to call 911 if C1 had a problem. C1 could talk to staff, management or C1 doctor if C1 had a problem. C1 would call 911 to report problems that C1 was having at the facility. C1 also didn’t like that staff would tell C1 what to do or redirect C1 if C1 was doing something wrong.

Staff interviewed that they have received training on how to treat clients in care and if they have seen staff mistreat clients, they would report it to management immediately. Staff interviewed stated that they would have to redirect C1 throughout the day making sure he was following house rules at the facility. Clients interviewed stated they have never been disrespected by staff and if they had would report it to staff or management immediately.

The investigation conclude that LPA Lund could not confirm or deny that C1 was mistreated during his stay at the facility.

Although the allegation may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Administrator Steven Bryant and a copy was emailed to Administrator Steven Bryant.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4