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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 08/07/2025
Date Signed: 08/07/2025 11:05:04 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
05/05/2025 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20250505162751
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:
08/07/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Lionel Bazan TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff withheld residents’ personal belongings

Staff mistreated residents
INVESTIGATION FINDINGS:
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5
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9
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12
13
Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Administrator Lionel Bazan and explained the reason for the visit. Census: 83

Staff withheld residents’ personal belongings -LPA Lund reviewed facility records, interviewed staff, and clients in care. Based on facility in-house reports dated 5/8/2025 the shoes have always been in Client (C1) possession that includes all three pairs of shoes. LPA Lund interviewed C1 who stated that C1 has had possession of all three pairs of shoes at all times and staff never took C1’s shoes.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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-20250505162751
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: 08/07/2025
NARRATIVE
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Based on facility in-house reports dated 5/8/2025, interviews with clients and staff on the information provided, it was unclear if staff withheld residents’ personal belongings, therefore the allegation was deemed UNSUBSTANTIATED.

Staff mistreated residents - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on facility records review, interviews with staff, and clients in care. Clients interviewed stated that staff have never mistreated them while living at the facility. Staff interviewed stated that they have never witnessed any staff mistreating any residents in care. All staff interviewed know that they are mandated reporters. All staff have initial training on how to report suspected adults and elderly abuse before working with clients 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.

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: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2