507203017-8-24-2023-27-AS-KHOS-CV6M7U-20230829092208

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507203017
Report Date: 08/24/2023
Date Signed: 08/24/2023 06:50:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2023 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20230317140836

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: 84	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Facility Manager Christian Jackson		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not provide medical attention to resident
Staff not treating residents with dignity and respect
Staff does not keep elevator free from odor
Staff withheld resident’s money
Facility elevator is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund was met with Facility Manager Christian Jackson and explained the reason for the visit.

Staff did not provide medical attention to resident- Based on records reviewed and interviews conducted with staff and clients in care. There were no Unusual/Incidents reports reported to CCL (Community Care Licensing) for Client (C1) in the date range of 2/1/2023 through 4/1/2023 for C1. Staff interviewed when clients come to staff and tell them they are not feeling well, staff will take them to the med room and check the residents out before making a decision to call for help (911) or have staff take them to the Emergency Room. Clients interviewed stated the staff are good at making sure their medical needs are being taken care of and staff will take a client to the med room and check them out to see what the next step will be.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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-20230317140836

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MODESTO RESIDENTIAL LIVING CENTER, LLC	FACILITY NUMBER: 507203017
	VISIT DATE: 08/24/2023

NARRATIVE

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Based on facility records review, interviews with staff and clients in care the information provided, it was unclear if staff did not provide medical attention to resident therefore the allegation was deemed UNSUBSTANTIATED.

Staff not treating residents with dignity and respect- Based on records review and interviews with staff and clients in care. Staff are trained on how to treat clients in care with training's such as Schizophrenia, other disorders training and one on one training. Staff (S1) denied any verbal abuse to clients in care. Management stated that staff would be fired immediately if any client was yelled at or spoken to with disrespect. The facility has a zero-tolerance policy for personal rights violations. LPA interviewed clients in care who stated the staff treat the clients with dignity and respect. Staff interviewed have never observed staff disrespecting clients in care and if they had would report it to management immediately.

Based on facility records review, interviews with staff and clients in care the information provided, it was unclear if staff not treating residents with dignity and respect therefore the allegation was deemed UNSUBSTANTIATED.

Staff does not keep elevator free from odor- Based on interviews with staff, clients in care records and observation. During LPA Lund’s visits on 3/22/2023 & 6/21/2023 observed the elevator free from odor and in good working order. Staff & clients interviewed stated that the elevator is free from odors. If there was to be an odor the facility staff would clean the elevator immediately.

Based on facility interviews with staff, clients in care and observation the information provided, it was unclear if staff does not keep elevator free from odor therefore the allegation was deemed UNSUBSTANTIATED.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230317140836

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MODESTO RESIDENTIAL LIVING CENTER, LLC	FACILITY NUMBER: 507203017
	VISIT DATE: 08/24/2023

NARRATIVE

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Staff withheld resident’s money- Based on records reviewed and interviews with staff, and clients. P&I records indicate that clients use their money for tickets, cigarettes, and cash mostly. LPA Lund interviewed client (C2) who stated that C2 does use P&I money to buy clothes when needed. C2 also uses P&I money to buy snacks and cigarettes and has always had availability to the P&I. LPA Lund reviewed four clients P&I money from 2/1/2023 through 6/30/2023 and found no discrepancies in the P&I. Clients interviewed stated that their P&I has never been withheld.

Based on facility records review, interviews with staff and clients in care the information provided, it was unclear if staff withheld resident’s money therefore the allegation was deemed UNSUBSTANTIATED.

Facility elevator is in disrepair- Based on records reviewed and interviews with staff, clients and observation. The facility has a permit to operate a Conveyance (Elevator) issued dated was 1/31/2023 from the State of California- Department of Industrial Relations- Division of Occupational Safety & Health. The inspection was on 12/5/2022 and permit expires on 12/5/2023. Staff interviewed stated that they have never had any issues with the elevator. Clients interviewed stated that they have never had any issues with the elevator. LPA Lund observed the elevator to be working on 6/21/2023 & 3/22/2023.

Based on facility records review, interviews with staff and clients the information provided, it was unclear if facility elevator is in disrepair
therefore, the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted with Facility Manager Christian Jackson and report left.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

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