390314809-10-14-2020-27-AS-KHOS-BX2Q9G-20210107105820

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 390314809
Report Date: 10/14/2020
Date Signed: 10/14/2020 02:37:55 PM

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
09/01/2020 and conducted by Evaluator Ruth Wallace

COMPLAINT CONTROL NUMBER: 27-AS-20200901082708

FACILITY NAME:	O'CONNOR WOODS ASSISTED LIVING		FACILITY NUMBER:	390314809
ADMINISTRATOR:	LEAL-MALLETE, PENNY		FACILITY TYPE:	741
ADDRESS:	3334 WAGNER HEIGHTS RD		TELEPHONE:	(209) 956-3400
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	499	CENSUS: 335	DATE:	10/14/2020
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Telephone Call - Pre-Caution COVID-19/Administrator Dawn Shimel		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Facility failed to safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Wallace contacted Administrator Dawn Shimel on this day to conclude a complaint investigation via telephone due to COVID-19 and pre-cautionary measures. A physical visit was not conducted in that the Department is not conducting Residential Care for the Elderly visits at this time, due to the COVID-19 virus.
During the investigation, LPA Wallace conducted interviews with Complainant, staff, one family member, Director of Memory Care, and Administrator. Resident's (R1) preplacement appraisal, resident personal property and valuables, memory care agreement, staff notes, Stockton police report, and physician's report. LPA did not find any negligence on the facility's part in not safeguarding the resident's personal belongings. The memory care agreement states that "facility shall not be responsible for the loss of any property belongs to you due to theft, fire, or any other cause, unless the loss or damage was caused by our negligence or that of our employees. We strongly recommend that you obtain, at your own expense, insurance for the replacement value of your personal property, at adequate coverage and liability limits."
The allegation is: Facility failed to safeguard resident's personal belongings. Unsubstantiated.
A finding that the complaint allegation(s) is 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 Administrator via telephone and a copy of 9099, Appeal Rights, and 811(Confidential Names) was provided to Administrator via email, an electronic email read receipt confirms receiving these documents. Administrator will sign 9099, and send back electronic email to LPA Wallace on today's date.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

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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