507203017-6-21-2023-27-AS-KHOS-CU5GN6-20230727052902

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 06/21/2023
Date Signed: 06/21/2023 03:03:47 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
03/02/2023 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20230302104445

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: 83	DATE:	06/21/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Facility Manager Christian Jackson		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility showers are not properly maintained for client's use

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund was met with Facility Manager Christian Jackson and explained the reason for the visit.
Facility showers are not properly maintained for client's use - Based on records reviewed and interviews conducted with staff, Reporting Party (RP) and Clients. RP stated that “RP observed three shower heads in each of the four showers for clients use”. Clients have a scheduled showers days posted in each client’s rooms with the time and day when each client takes a shower. LPA Lund interviewed eight clients in care, and they stated that for the most part they can take a shower anytime they want including the time scheduled or another time if needed/wanted. Staff and clients interviewed have never seen more than one client at a time in the shower. LPA Lund observed the bathrooms to be clean, and safe for the clients in care. LPA Lund observed that only one shower head work for each bathroom and a privacy shower curtain and an ADA bench in two of the shower’s rooms for clients who need it. LPA Lund reviewed eight clients LIC602’s stating that clients bath self with no help of staff.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230302104445

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: 06/21/2023

NARRATIVE

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Based on facility records review, interviews with staff, clients, and RP the information provided, it was unclear if facility showers are not properly maintained for client's use therefore the allegation was deemed UNSUBSTANTIATED.

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 Facility Manager Christian Jackson and report left

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC9099 (FAS) - (06/04)

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