392700306-3-10-2022-27-AS-KHOS-CCJJUZ-20220315072223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 03/10/2022
Date Signed: 03/10/2022 11:52:14 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
01/24/2022 and conducted by Evaluator Bruce Jacobs

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220124141918

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: 56	DATE:	03/10/2022
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Gurpreet Rai, Facility Administrator		TIME COMPLETED:	11:55 AM

ALLEGATION(S):

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Resident is not assisted with their medication in a timely manner
Staff does not provide adequate meal service to residents in care
Staff did not provide laundry services to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Facility Administrator Gurpreet Rai to deliver investigation findings on the above allegations. This investigation consisted of site inspections to the facility to conduct interviews with the facility administrator, staff and residents. LPA reviewed and obtained copies of resident placement and medical files.

This investigation concluded after several LPA inspections, interviews and record reviews that the facility is administering medications as prescribed and recording the administration in the Medication Administration Record. LPA reviewed menus, observed several meals and interview the facility cook and kitchen staff. Meals and menus were determined to meet nutritional requirements and of sufficient quality. There was not sufficient information to prove facility staff did not provided services listed on admission agreement(s) including laundry service as required

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: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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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