392700306-12-10-2021-27-AS-LKIG-C9SNFD-20211217092521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 12/10/2021
Date Signed: 12/10/2021 02:03:32 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
11/18/2021 and conducted by Evaluator Bruce Jacobs

COMPLAINT CONTROL NUMBER: 27-AS-20211118142859

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: 54	DATE:	12/10/2021
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Katrice Collins, Facility Administrator		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Resident does not receive proper meal assistance

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Administrator Katrice Collins to deliver investigation findings on the above allegation. This investigation consisted of site inspections to the facility to conduct interviews with the facility administrator, staff, residents and other witnesses. LPA reviewed and obtained copies of the resident's (R-1) files and other documentation.

This investigation concluded after several LPA inspections, interviews and record reviews that there was inadequate evidence to conclude that Resident (R-1) does not receive proper meal assistance . LPA interviewed the Facility Administrator, Facility staff and other witnesses who provided conflicting information on the allegation. LPA was able to observe the resident's admission agreement, meal schedule and information on meal service to the resident's room as well

Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are determined to be UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce Jacobs	TELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021

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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