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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700306
Report Date: 01/17/2024
Date Signed: 01/30/2024 12:54:30 PM


Document Has Been Signed on 01/30/2024 12:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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:80CENSUS: DATE:
01/17/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Manisha PunniTIME COMPLETED:
12:00 PM
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An office meeting was held today via Microsoft Teams with the Sacramento South Regional Office. The purpose of this meeting is to discuss the status of keeping the facility on continued Quarterly visits. Present in the meeting is Regional Manager (RM) Stephanie Doub, Licensing Program Manager (LPM) Liza King, and Licensing Program analyst (LPA) Kesha Lewis, Kathryn Thomas (Ombudsmen). Representing WAGNER HEIGHTS RESIDENTIAL: Rosalie Sullivan, Administrator: Manisha Punni, and (president) Dana Ashley.

The NCC was held on 6/23/2023,the facility has had increased monitoring since the informal date of 08/29/22. From that date the RO conducted a 2nd informal on 03/17/23 and an NCC on 06/23/23. the facility has had six (6) complaints during the 2023 year and five (5) type A citations. TSP was given under last administration in late 2022 and early 2023. Medication logs are an ongoing problem narcotics logs continue to be missing signatures, the facility was cited for this on the last quarterly visit on 01/10/2024. There has been much improvement with resident files such as services plans and individual resident MAR'S being singed. During the quarterly visits LPA reviewed Maintenance logs, Medication log sheets, Updated AWOL procedures, Recent incident reports, Random resident medical assessments and Training records all training is up to date.

The facility agrees to have administrator or resident care coordinator audit narcotics log daily, provide staff with additional training on medication procedure's. The regional office will continue additional monitoring for six (6) more months and a follow up meeting will be held in August of 2024.

Topics of Discussion:
Care and Supervision
Medication Management
Copy of report emailed to Manisha Punni.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (916) 764-1024
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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