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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 09/19/2025
Date Signed: 09/19/2025 01:41:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2025 and conducted by Evaluator Kesha Lewis
COMPLAINT CONTROL NUMBER: 27-AS-20250725100252
FACILITY NAME:WAGNER HEIGHTS RESIDENTIALFACILITY NUMBER:
392700306
ADMINISTRATOR:MANISHA PUNNIFACILITY TYPE:
740
ADDRESS:2435 WAGNER HEIGHTS RDTELEPHONE:
(209) 477-5353
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:0CENSUS: 65DATE:
09/19/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Angela RingueTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Licensee did not ensure that resident was receiving showers as necessary.
Licensee did not ensure that resident's adult briefs were changed and that the resident was kept clean and dry
INVESTIGATION FINDINGS:
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On 09-19-25, Licensing Program Analyst (LPA) Kesha Lewis and Licensing program manager Liza King arrived unannounced to continue the complaint investigation for the allegations noted above. LPM/LPA met with the administrator and explained the purpose of the visit.

LPM requested five (5) resident ADL'S sheets. Based on records reviewed three (3) out of the five (5) residents did not have a shower in the month of July 2025. While walking down the hall a malodorous smell was present in the facility during today’s visit and LPA Lewis observed the same smell during a during a different visit to the facility. Therefore, the allegation that the Licensee did not ensure that resident was receiving showers as necessary and Licensee did not ensure that resident's adult briefs were changed, and that the resident was kept clean and dry is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies are being cited from the California Code of Regulations (CCR) and/or the Health and Safety Code.
An exit interview was conducted, and a copy of this report and appeal rights were given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025
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-20250725100252
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WAGNER HEIGHTS RESIDENTIAL
FACILITY NUMBER: 392700306
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/20/2025
Section Cited
CCR
87464(c)
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Basic services shall at a minimum include:
c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care.
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No POC due facility is noe closed.
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Based on records review three (3) out of the five (5) residents did not have a shower in the month of July 2025.
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Type B
09/23/2025
Section Cited
CCR
87463(3)
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(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This was not met as evidenced by
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No POC due Facility is now closed.
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The hallway area was malodorous this is a potentail risk to clients 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.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2