392700306-8-27-2020-27-AS-SDOB-BU4QPG-20201005122039

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 08/27/2020
Date Signed: 08/27/2020 09:23:03 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
06/12/2020 and conducted by Evaluator Anthony Tuck

COMPLAINT CONTROL NUMBER: 27-AS-20200612160326

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:	08/27/2020
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Katrice Collins		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Facility operating at an uncomfortable temperature.

Facility has insects.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anthony Tuck 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 Anthony Tuck conducted four resident interviews, one interview with the Administrator, LPA also obtained facility temperature logs recording thermostat readings and invoices from exterminator company.
The first allegation is the facility operating at an uncomfortable temperature.
It was alleged that the facility is operating at an uncomfortable temperature due to resident complaining temperature being too cold having to use 4 blankets and wear a hat to keep warm. LPA Tuck conducted 4 resident interviews over the phone. Resident 1, 2, 3 indicated that they have not experienced any issues with the temperature being too hot or cold. Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Anthony Tuck	TELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

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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Control Number 27-AS-20200612160326

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: 08/27/2020

NARRATIVE

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Resident 4 indicated that it is cold in the room, however Resident 4 also reported having medical conditions which may cause resident to be colder than others. LPA Tuck obtained copies of maintenance reports indicating daily temperature readings from the thermostat with temperatures ranging from 71 degrees to 78 degrees Fahrenheit with date ranges from 05/20/2020 - 06/19/2020. Based on interviews, and pertinent documentation reviewed from the facility, the Department (CCLD) has found the allegation of the facility operating at uncomfortable temperatures, 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 that the facility has insects. It was alleged that insects have been seen on toilet paper. LPA Tuck conducted interviews with four residents regarding insects in resident rooms. Resident 1 stated that there have been no bugs found in their room. Resident 2 reported seeing a spider and a beetle in their bathroom, but the exterminator comes to spray for bugs. Resident 3 stated not seeing any bugs in their room. Resident 4 stated seeing a spider in their room once but has not seen any bugs in a few months. LPA obtained copies of service invoices from the administrator indicating dates of service performed by the exterminator company on 01/06/2020, 02/13/2020, 04/21/2020. The invoice indicates regular services performed by the exterminator for control and prevention of entry to insects and rodents in and around the facility.

Based on interviews, and pertinent documentation reviewed from the facility; the Department (CCLD) has found the allegation of insects in the facility, 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 Tuck on today's date.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Anthony Tuck	TELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

LIC9099 (FAS) - (06/04)

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