507203017-9-19-2025-27-AS-LRIS-DLSMUR-20250923095535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 09/04/2025
Date Signed: 09/19/2025 09:42:27 AM

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
06/02/2025 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20250602152105

FACILITY NAME:	MODESTO RESIDENTIAL LIVING CENTER, LLC		FACILITY NUMBER:	507203017
ADMINISTRATOR:	PATRICIA A CALLA		FACILITY TYPE:	735
ADDRESS:	1932 EVERGREEN AVE		TELEPHONE:	(209) 530-9300
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	100	CENSUS: 84	DATE:	09/04/2025
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Administrator Patricia Calla		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility air condition is in disrepair

Staff did not provide adequate supervision to residents resulting in resident’s eloping from the facility

Staff did not provide communication to residents authorized representatives

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 Patricia Calla and explained the reason for the visit. Census: 84
Facility air condition is in disrepair - LPA Lund interviewed staff, and clients in care. Based on reviewed facility records, interviews with staff, and clients in care. On June 6, 2025 the facility purchased portable AC units and separated through out the facility. On 12/13/2024 the facility paid $327700.00 dollars to replace the heating system. The facility through the summer took clients to sister facility Carver Care Residential when needed. Staff interviewed stated the facility is kept cool enough to meet the clients needs. Clients interviewed stated that the facility has been kept cool enough.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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-20250602152105

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: 09/04/2025

NARRATIVE

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Based on reviewed facility records, interviewed staff, and clients in care, on the information provided, it was unclear if facility air condition is in disrepair, therefore the allegation was deemed UNSUBSTANTIATED.
Staff did not provide adequate supervision to residents resulting in resident’s eloping from the facility - LPA Lund reviewed facility records, interviewed staff, and residents in care. Client (C1) LIC602 states that C1 can leave the facility unassisted. On 5/31/2025 C1 eloped from the facility and returned on 6/2/2025. The facility has a elopement protocol which followed. Staff interviewed stated they have procedures clients in care regarding elopement procedures. Residents interviewed stated that staff do check there rooms to see if they are there and walk around to check on clients.

Based on facility records review, interviews with clients and staff on the information provided, it was unclear if staff did not provide adequate supervision to residents resulting in resident’s eloping from the facility, therefore the allegation was deemed UNSUBSTANTIATED.

Staff did not provide communication to residents authorized representatives - LPA Lund reviewed facility records, interviewed staff, and witness. Based on facility records reviewed and interviews with staff, and witness. When a clients in care elopes from the facility the facility has procedures in place to notify facility manager, family member, case manager, conservator, Modesto PD and licensing. The facility will call whom they need to call and send a email to the agency if needed. Staff stated that will notify management immediately if a client in care has eloped.

Based on facility records review, interviews with staff and witness on the information provided, it was unclear if staff did not provide communication to residents authorized representatives, 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: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

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