507203017-12-26-2023-27-AS-KHOS-CZBLJ7-20240109074727

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 12/26/2023
Date Signed: 12/26/2023 03:51:20 PM

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
09/12/2023 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20230912155334

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: 95	DATE:	12/26/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Administrator Steven Bryant		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff member yells at residents

Facility does not have sufficient staff to meet the needs of the residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Administrator Steven Bryant and explained the reason for the visit.

Staff member yells at residents- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on facility records review, interviews with staff, and residents in care. Residents interviewed stated that they have had no staff yell at them while living at the facility. Staff interviewed stated that they have never witnessed staff yelling at any residents in care.

Based on facility records review, interviews with clients and staff on the information provided, it was unclear if staff member yells at residents, therefore the allegation was deemed UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023

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-20230912155334

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: MODESTO RESIDENTIAL LIVING CENTER, LLC	FACILITY NUMBER: 507203017
	VISIT DATE: 12/26/2023

NARRATIVE

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Based on facility records review, interviews with clients and staff on the information provided, it was unclear if staff member yells at residents, therefore the allegation was deemed UNSUBSTANTIATED.

Facility does not have sufficient staff to meet the needs of the residents in care- LPA Lund reviewed facility records, interviewed staff, and residents in care. The facility doesn’t have any clients that need help with their activities of daily living skills, such as bathing, eating and mobility. The staff do reminders to residents in care for bathing but do not help with bathing. Residents interviewed stated that the facility staff has been able to meet their needs during there stay at the facility. Staff interviewed stated that they had sufficient staff to met the needs of the clients in care.

Based on facility records review, interviewed staff, and residents in care on the information provided, it was unclear if facility does not have sufficient staff to meet the needs of the residents in care, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023

LIC9099 (FAS) - (06/04)

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