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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 07/29/2022
Date Signed: 07/29/2022 12:09:45 PM

Substantiated


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
07/20/2022 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20220720153737
FACILITY NAME:WAGNER HEIGHTS RESIDENTIALFACILITY NUMBER:
392700306
ADMINISTRATOR:GURPREET RAIFACILITY TYPE:
740
ADDRESS:2435 WAGNER HEIGHTS RDTELEPHONE:
(209) 477-5353
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:80CENSUS: 57DATE:
07/29/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Gurpreet RaiTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Illegal Eviction
INVESTIGATION FINDINGS:
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On 7-29-22 at 10:15am, Licensing Program Analysts (LPAs) Michael Bilger and Renee Campbell arrived unannounced to open and investigate the complaint allegation noted above. LPAs met with Administrator Gurpreet Rai and explained the purpose of the visit. LPAs interviewed Administrator and requested copy of 30-day eviction notice for resident1 (R1). Based on interview and record review, it was determined that a 30-day notice dated 6-17-22 for R1 was issued to R1's responsible party on 6-17-22. It was further determined based on record review and interview that a 30-day notice for R1 was not sent to licensing department per regulatory requirements.

Based on interviews and record reviews, the preponderance of evidence standard is met and this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6. An exit interview was conducted with Gurpreet Rai and a copy of this report was left with Gurpreet. Appeal Rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
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 2
Control Number 27-AS-20220720153737
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2022
Section Cited
CCR
87224(f)
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Eviction Procedures. (f)A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement is not met as evidenced by:
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Licensee will read regulation 87244(f) and submit a sign delcaration of understanding to LPA by POC due date.
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Based on interview and record review, Licensee and Administrator did not ensure a copy of a 30-day eviction notice for R1 was submitted to licensing department within five (5) days. This poses a potential health, safety, and resident rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2