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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 05/01/2025
Date Signed: 05/01/2025 10:36:36 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
01/29/2025 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20250129150012
FACILITY NAME:MODESTO RESIDENTIAL LIVING CENTER, LLCFACILITY NUMBER:
507203017
ADMINISTRATOR:PATRICIA A CALLAFACILITY TYPE:
735
ADDRESS:1932 EVERGREEN AVETELEPHONE:
(209) 530-9300
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:100CENSUS: 83DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Assistant Administrator Lionel Bazan TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff punched resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegation. LPA Lund met with Assistant Administrator Lionel Bazan and explained the reason for the visit.

Staff punched resident- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on facility records review all staff have training in injury prevention, report of suspected dependent/elderly abuse and personal rights. LPA Lund interviewed Client (C1) who stated on 01/18/2025 that staff (S1) hit C1. Staff interviews stated that C1 hit another client and staff. Modesto PD (Report # MP- 250180120) and crisis team was called out to evaluate C1. C1 refused any help from Modesto PD or the crisis team.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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-20250129150012
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: 05/01/2025
NARRATIVE
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The facility contacted C1 case manager and C1 was not able to go out to community for 3 days. The facility also did 15- minute bed checks on C1. Residents interviewed stated that they have not been handled in a rough manner. Staff interviewed stated that they have never witnessed staff handling residents in care in a rough manner. They have had training own how to talk and work with the residents in care. Staff interviewed also stated if they were to witness a staff member handle a resident in a rough manner, they would immediately report it to management.

Based on facility records reviewed, interviews with clients and staff on the information provided, it was unclear if staff punched resident, 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: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2