<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 09/13/2022
Date Signed: 09/13/2022 12:37:41 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
06/07/2022 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20220607111537
FACILITY NAME:MODESTO RESIDENTIAL LIVING CENTER, LLCFACILITY NUMBER:
507203017
ADMINISTRATOR:DENNIS MONTEROSSOFACILITY TYPE:
735
ADDRESS:1932 EVERGREEN AVETELEPHONE:
(209) 530-9300
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:100CENSUS: DATE:
09/13/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrative Assistant Christian JacksonTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not report an unusual incident to resident's representative
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jason Lund arrived at the above facility to deliver findings for a complaint. LPA was met by Administrative Assistant Christian Jackson and explained the reason for the visit.
Facility staff did not report an unusual incident to resident's representative- Based on facility records reviews, interviews with staff, and witness. The facility reported on 10/10/2021 that client (C1) was in custody to Turning Point Housing/Employment Specialist. C1 was in custody from 10/9/2021 through 12/28/2021 and was paid through October at the time of C1 being in custody. Turning Point made it clear to the facility that they wanted to keep C1 bed (Spot) available for C1 when C1 was released from custody. Turning Point also had communication with San Joaquin Conservator Office regarding such custody and wanting to keep the spot available for C1 when C1 was released from custody. The facility kept C1’s weekly allowance for C1 until C1 was back to the facility.
The Department (CCLD) has found the allegations. Unsubstantiated.
A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.
Exit interview held with Administrative Assistant Christian Jackson and report left.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
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 1