392700306-7-19-2023-27-AS-KHOS-CUANUN-20230801104637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 07/05/2023
Date Signed: 07/19/2023 02:57:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
05/26/2023 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20230526162401

FACILITY NAME:	WAGNER HEIGHTS RESIDENTIAL		FACILITY NUMBER:	392700306
ADMINISTRATOR:	MANISHA PUNNI		FACILITY TYPE:	740
ADDRESS:	2435 WAGNER HEIGHTS RD		TELEPHONE:	(209) 477-5353
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	80	CENSUS: 57	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	11:18 AM
MET WITH:	Manisha Punni		TIME COMPLETED:	11:19 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not providing a comfortable temperature for residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver findings for a complaint for the above allegations. LPA was greeted by Administrator and explained the reason for the visit

Allegation 1 Staff are not providing a comfortable temperature for residents is UNSUBSTATIATED. Based on LPA observation and interviews of S1 and also R1-R2 LPA was not able to find the allegation did or did not occur. Due to the information gathered LPA finds allegation to be UNSUBSTATIATED. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was left

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
05/26/2023 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230526162401

FACILITY NAME:	WAGNER HEIGHTS RESIDENTIAL		FACILITY NUMBER:	392700306
ADMINISTRATOR:	MANISHA PUNNI		FACILITY TYPE:	740
ADDRESS:	2435 WAGNER HEIGHTS RD		TELEPHONE:	(209) 477-5353
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	80	CENSUS: 57	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	11:18 AM
MET WITH:	Manisha Punni		TIME COMPLETED:	11:19 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are pressuring resident for confidential information
Facility yard is in disrepair

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver findings for a complaint for the above allegations. LPA was greeted by Administrator and explained the reason for the visit

Allegation 1 Staff are pressuring resident for confidential information and allegation 2 Facility yard is in disrepair are unfounded. Based on LPA observation and interviews for S1 and S2 also R1-R2 LPA was not able to find the allegation to be true. Due to the information gathered LPA finds allegation to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened.

An exit interview was conducted and a copy of this report was left

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
05/26/2023 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230526162401

FACILITY NAME:	WAGNER HEIGHTS RESIDENTIAL		FACILITY NUMBER:	392700306
ADMINISTRATOR:	MANISHA PUNNI		FACILITY TYPE:	740
ADDRESS:	2435 WAGNER HEIGHTS RD		TELEPHONE:	(209) 477-5353
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	80	CENSUS: 57	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	11:18 AM
MET WITH:	Manisha Punni		TIME COMPLETED:	11:19 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility has water damage
Facility floors are in disrepair
Resident's call button is in disrepair
Residents sliding door is in disrepair
Staff did not check on resident in a timely manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver findings for a complaint for the above allegations. LPA was greeted by Administrator and explained the reason for the visit

Allegations 1-5 are substantiated based on LPA observation during the Annual inspection. The above allegations were cited during the annual visit on 05/04/2023. Plans of corrections were submitted and corrected. Repairs are completed or pending receiving an order so they can be completed. As a result, the preponderance of evidence standard for this allegation is met, therefore, this allegation is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met.
See citations from 05/04/2023.

An exit interview was conducted and a copy of this report was left

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3