392700306-6-16-2020-27-AS-LKIG-BQXNGV-20200626102747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 06/16/2020
Date Signed: 06/16/2020 10:04:41 AM

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
05/07/2020 and conducted by Evaluator Ruth Wallace

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200507132608

FACILITY NAME:	WAGNER HEIGHTS RESIDENTIAL		FACILITY NUMBER:	392700306
ADMINISTRATOR:	COLLINS, KATRICE		FACILITY TYPE:	740
ADDRESS:	2435 WAGNER HEIGHTS RD		TELEPHONE:	(209) 477-5353
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	80	CENSUS: 57	DATE:	06/16/2020
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Telephone Call with Katrice Collins		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident falls due to lack of supervision.
Medications are not being stored properly or administered to residents according to Physicians Orders.
Insufficient staff to meet resident(s) needs.
Staff are not qualified or trained properly.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Wallace contacted Administrator Katrice Collins 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 three staff interviews, one attempted staff interview, Administrator, and the Complainant.

The first allegation is residents are falling due to a lack of supervision.

It was alleged that residents are falling due to lack of supervision. LPA reviewed staff schedule and incident reports from April 2020. In Title 22 Regulations under 87415 (a) (2) facilities that are caring for sixteen to one hundred residents only need to have at least one employee on duty and awake. Another employee shall be on call, and capable of responding within ten minutes.
Continued on 9099-C

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: 06/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020

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 3

Control Number 27-AS-20200507132608

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: WAGNER HEIGHTS RESIDENTIAL	FACILITY NUMBER: 392700306
	VISIT DATE: 06/16/2020

NARRATIVE

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Facility has at least one Caregiver on duty for all three shifts as well as a Medication Technician. A Licensed Vocational Nurse is on at least one of the shifts as well. There were approximately five incident reports submitted to Community Care Licensing during the month of April 2020. Appropriate action was taken for each incident. 911 was called when needed, family were notified, and Administrator called if there were any serious falls or accidents.

Based on interviews, LPA's observations, and records review, the Department (CCLD) has found the allegation of resident falling due to lack of supervision 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.

Second allegation is medications are not being stored properly or administered to residents according to Physicians Orders. It was alleged that medications are not being stored properly or being administered to residents according to Physicians orders. LPA reviewed in detail medication logs, Physicians orders, incident reports, and staff training on medications. Documentation did not reflect medications being stored improperly and or residents not receiving medications according to Physicians Orders.

Based on interviews, LPA's observations, and records review; the Department (CCLD) has found the allegation of medications are not being stored properly or administered to residents according to Physicians Orders. 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.

Third allegation is insufficient staff to meet resident(s) needs. It was alleged that there is insufficient staff to meet resident(s) needs. LPA reviewed staffing hours for the three shifts and adequate staffing has been provided at the facility. Title 22 regulations does not have a specific number of staff required in Community Care Licensing regulations. LPA interviewed staff regarding shifts and some staff do work double shifts on occasion. Staffing is based on the number of residents currently residing at facility and the amount of direct care needed for residents. Continue on second 9099-C

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20200507132608

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: WAGNER HEIGHTS RESIDENTIAL	FACILITY NUMBER: 392700306
	VISIT DATE: 06/16/2020

NARRATIVE

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Continued from first 9099-C

Based on interviews, LPA's observations, and records review; the Department (CCLD) has found the allegation of insufficient staff to meet resident(s) needs 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.

Fourth allegation is staff are not qualified or trained properly.

It was alleged that staff is not qualified or trained properly. LPA reviewed all the initial staff training required when first hired. All new staff are required to do twenty-four hours of initial training. In addition, each employee must do sixteen hours of videos and tests. Once a month there is a mandatory staff meeting where a different topic is picked to discuss, as well as Administrator disseminates important information for employees to have regarding corporation policies and procedures.

Based on interviews, LPA's observations, and records review; the Department (CCLD) has found the allegation of staff are not qualified or trained properly 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.

There were no deficiencies cited on today’s date.

An exit interview was conducted with Administrator Katrice Collins via telephone and a copy of 9099, 9099-C's, Appeal Rights, and 811(Confidential Names) was provided to Katrice via email, an electronic email read receipt confirms receiving these documents. Administrator will sign 9099, 9099-C's and send back electronic email to LPA Wallace on today's date.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020

LIC9099 (FAS) - (06/04)

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