392700109-9-19-2022-27-AS-KHOS-CJGMUG-20220921095508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700109
Report Date: 09/19/2022
Date Signed: 09/19/2022 05:19:53 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
08/18/2022 and conducted by Evaluator Maja Jensen

COMPLAINT CONTROL NUMBER: 27-AS-20220818154005

FACILITY NAME:	DELTA AT THE SHERWOODS		FACILITY NUMBER:	392700109
ADMINISTRATOR:	LEAH ZUBIATE		FACILITY TYPE:	740
ADDRESS:	1215 W SWAIN ROAD		TELEPHONE:	(209) 689-3180
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	42	CENSUS: 37	DATE:	09/19/2022
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Craig Vincelet		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility does not have enough food for residents in care
Staff withhold food from residents
Snacks are not being given to residents
Call system is in disrepair
Facility does not offer activities for residents
Back door alarm is in disrepair
Meals are not planned with consideration for cultural and religious background and food habits of residents

INVESTIGATION FINDINGS:

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On 9/19/22 at approximately 11:45am, Licensing Program Analyst (LPA) Jensen arrived unannounced to continue a complaint investigation in to the above listed allegations. LPA Jensen met with Craig Vincelet and explained the purpose of today's visit.

Facility does not have enough food for residents in care
LPA Jensen observed 7 days of non-perishable food in the facility and in excess of two days of fresh fruit on 8/22/22 and on 9/19/22. Based on an interview with site administrator Craig Vincelet, food is brought in from another site daily and prepped at this facility for meals therefore the majority of the perishable food is not on site. LPA Jensen interviewed 7 staff members and 3 residents. The staff members interviewed consisted of a combination of former and current staff. The majority of staff and residents interviewed indicated they have enough food. LPA Jensen observed lunch service on 9/19/22 and lunch was observed to consist of a bag of chips, a hot dog, and a piece of fruit. Based on interviews conducted and observations made during the course of 2 unannounced visits the allegation is UNSUBSTANTIATED. Continued on LIC 9099C....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022

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-20220818154005

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: DELTA AT THE SHERWOODS	FACILITY NUMBER: 392700109
	VISIT DATE: 09/19/2022

NARRATIVE

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Staff withhold food from residents
LPA Jensen interviewed 7 staff members and 3 residents. The staff members interviewed consisted of a combination of former and current staff. The majority of those interviewed denied food was withheld from residents. On 9/19/22 during the course of the visit, LPA Jensen observed 3 residents request snacks outside of the regularly scheduled snack times and 3 of 3 residents were given snacks without hesitation. Based on interviews conducted and observations made during the course of the visit, the allegation that staff withhold food from residents is UNSUBSTANTIATED.

Meals are not planned with consideration for cultural and religious background and food habits of residents
LPA Jensen interviewed 7 staff members and 3 residents. The staff members interviewed consisted of a combination of former and current staff. The majority of parties interviewed denied having a problem with meals not being planned with consideration for cultural or religious preference. Based on the interviews the allegation is UNSUBSTANTIATED.

Snacks are not being given to residents
LPA Jensen interviewed 7 staff members and 3 residents. The staff members interviewed consisted of a combination of former and current staff. The majority of those interviewed denied the allegation that snacks are not being given to residents. During the course of the visit on 9/19/22 LPA Jensen observed 3 random residents request snacks outside of regularly scheduled snacks times and snacks were given by staff without hesitation therefore the allegation is UNSUBSTANTIATED.

Call system is in disrepair
LPA Jensen interviewed 7 staff members and 3 residents. The staff members interviewed consisted of a combination of former and current staff. On 8/22/22 LPA Jensen tested the alert system with site supervisor in a resident's room. Staff responded to the room in a reasonable amount of time. On 9/19/22 LPA Jensen requested the alert system be activated in a randomly chosen room number while the LPA stood in the medication room with site supervisor Craig Vincelet.
Continued on LIC 9099C....

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20220818154005

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: DELTA AT THE SHERWOODS	FACILITY NUMBER: 392700109
	VISIT DATE: 09/19/2022

NARRATIVE

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Continued from LIC 9099C....

LPA Jensen observed the alert system accurately identified the room number and initiated an audible sound to alert staff of the activation. The alert system was observed to function as required. Based on interviews conducted and observations made during the testing of the alert system, the allegation is UNSUBSTANTIATED.

Facility does not offer activities for residents
LPA Jensen interviewed a former staff member, a current staff member and 3 residents. The majority of parties interviewed claimed there are sufficient activities available for residents. The parties interviewed advised the facility has activities such as outings, bingo, socialization groups, reading, crosswords and exercise activities. During the course of the visit LPA Jensen observed a putting green for use by the residents. Based on interviews conducted and observations made the allegation is UNSUBSTANTIATED.

Back door alarm is in disrepair
LPA Jensen tested the alarm on the exit door by the men's hall closest to room number 1 at approximately 12:05pm with Craig Vincelet. The exit consists of double doors with delayed egress that should sound an alarm when opened. If a person were to exit these doors there are gates on facility grounds that would have to be opened as well in order to leave the property. The alarm did not sound when the doors were tested. Site Administrator Craig Vincelet replaced the battery in the door alarm. After the battery was replaced, the alarm on the door functioned properly. Based on observations the alarm on the door was not in disrepair but rather out of battery therefore the allegation is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means that although the violations may have occurred as reported the preponderance of evidence standard was not met.

An exit interview was conducted with site supervisor Craig Vincelet and a copy of this report, appeal rights and confidential names list was given.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022

LIC9099 (FAS) - (06/04)

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