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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 12/16/2022
Date Signed: 12/16/2022 12:11:28 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
08/29/2022 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20220829162223
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: 83DATE:
12/16/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Assistant Meisha McDonald TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility illegally evicted resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund was met with Administrator Assistant Meisha McDonald and explained the reason for the visit.

Facility illegally evicted resident- Based on records reviewed and interviews conducted with staff, and witness. Client (C1) received a 30- day notice on 7/5/2022 and reported it to local ombudsman because the notice didn’t have the proper resources on the 30- day notice. The facility did have valid reasons to evict C1 but the 30- day notice didn’t have the resources to find another facility. The facility Administrator Christian Jackson stated, “The facility would not evict C1 without C1 having another play to stay (Live).” The facility, C1 and the ombudsman office had a meeting on date to discuss a plan of action (Rescinded) for C1 to stay at the facility if C1 can follow the house (Facility) rules and keep in compliance with COVID-19 regulations.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
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 2
Control Number 27-AS-20220829162223
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: 12/16/2022
NARRATIVE
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Based on records review and interviews the facility didn’t give a proper 30- day notice but rescinded the notice as long as C1 follows house (Facility) rules and keep in compliance with COVID-19 regulations.

Based on facility records, interviews with staff and witness on the information provided, C1 was not illegally evicted therefore the allegation was deemed UNSUBSTANTATED.

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.



An exit interview was conducted with Administrator Assistant Meisha McDonald
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2