507203017-7-13-2026-27-AS-LKIG-DW9QKH-20260723121418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 07/13/2026
Date Signed: 07/13/2026 01:54:32 PM

Substantiated

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
04/20/2026 and conducted by Evaluator Noel Wolf Petersen

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260420105628

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: 77	DATE:	07/13/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Gena Garibay		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not provide a safe environment for resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst, Noel Wolf Petersen, arrived unannounced to the facility to conduct a complaint investigation into the above allegations. LPA met with Financial Manger Gena Garibay, to explain the purpose of the visit.

LPA conducted 8 client interviews and 8 staff interviews, roughly 10% of the population of residents. a concensus statement was made, 11 of 16, clients and staff report several incidents where residents are engaging in behavior that meets a definition as physical abuse in the past three months. Only 3 of 16 interviewed feel the facility is unsafe, all three were concerned with outbursts of rage by a particular client R1.

LPA conducted a record review of recent incident reports going back to January 2026, The facility has not furnished licensing with reports of physical abuse, in a few months. LPA attempted to review R1's needs and services plan, last updated 10/17/25 they don't include intervention methods. dialiy care notes have a physical altercation with two staff, 4/27/26, that resulted in a trip to the acute behavioral. That unexpected absense from the facility did not make it to being reported to licesing Per interview with Facility Manager. Continued on C Page.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026

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 4

Control Number 27-AS-20260420105628

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/13/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/21/2026 Section Cited CCR 80061(a)(1)(E)	1 2 3 4 5 6 7	80061 Reporting Requirements (a) Each licensee or applicant shall furnish to the licensing agency reports as required by the Department, including, but not limited to, those specified in this section. (1) Events reported shall include the following: (E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client.	1 2 3 4 5 6 7	Lpa suggests that a training for abuse reporting staff wide. signed up in a week, send that completed log of everybody who took it when complete, LPA will ask for an update in 8/13/26
	8 9 10 11 12 13 14	This requirement was not meet as evidnced by: record review and interview where licensing side records dont have recived a 624, and intervew with facility manager that the internal report exists but was not sent out. This requirement not being followed posed a risk to clients in care, in terms of safety, health, or personal rights.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4

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
04/20/2026 and conducted by Evaluator Noel Wolf Petersen

COMPLAINT CONTROL NUMBER: 27-AS-20260420105628

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:	DATE:	07/13/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:			TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff threaten resident.
Staff do not intervene between resident threatening another resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst, Noel Wolf Petersen, arrived unannounced to the facility to conduct a complaint investigation into the above allegations. LPA met with Financial Manger Gena Garibay, to explain the purpose of the visit.

Staff are reporting: 5 of 8 staff are aware of some physical altercation between the residents in the past three months, 3 of 8 are reporting having intervened in a physical altercation about the safety of the residents.

Residents are reporting: 8 of 8 clients are reporting feeling safe in a general sense at the facility, 3 of 8 are reporting concerns of being unsafe around a particular client because particular client has sudden outbursts of rage. No residents reported being threatened by a staff. No residents reported non intervention by staff.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. A copy of the report was read and given to the staff. Left with the email on file. Exit interview conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20260420105628

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: 07/13/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, is being cited on the attached LIC 9099D.

LPA gave guidance for the facility to review policies and procedures for the 80068 Admission Agreement, 80061 Mandatory Reporting Requirements, and 85068.3 Modification of Needs and Services plans.

Per 1(b) of the House Rules contained in Admission Agreement, assaultive behavior from a client is prohibited. The department has a preference for the internal response to client and staff grievances by the facility not to lead to immediate eviction in most cases, LPA gave guidance to enforce the admission agreement, but best practices for grievance procedures are to have a open door management style for clients and staff to bring up concerns in person paired with a suggestion box where concerns can be raised anonymously.

Mandatory Abuse reporting requirements and timelines should be addressed with the care staff, and the other reporting requirements should be addressed with support/managing staff. Needs and services plans should address aggressive behaviors and how the client reacts to different interventions.

appeal rights were provided. a copy of the report was read and given to the staff, Left with the email on file.. Exit interview conducted

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4