392700306-2-25-2021-27-AS-KHOS-BYQKAK-20210302064404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 02/25/2021
Date Signed: 02/25/2021 02:51:34 PM

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
10/12/2020 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20201012142344

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: 43	DATE:	02/25/2021
		UNANNOUNCED	TIME BEGAN:	01:26 PM
MET WITH:	Katrice Collins		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Illegal eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Johnson contacted the Administrator Katrice Collins to deliver finding for the complaint received on 10/14/2020. A physical visit was not conducted in the Department is not conducting Residential Care for the Elderly at this time, due to the COVID-19 virus.

Allegation: Illegal eviction. Based on interviews with the Administrator and Assistant Business Office Manager Marivic Andrade, R1 owns approximately $5,000.00 dollars for past rent and has paid portions of past due rent. The facility is working with R1 to recover the remaining past due amount owned and is also in contact with R1 mother who is assisting in the process as well. The facility did give notice R1 a 30 day eviction due to the past due amount of rent in addition to behavior challenges that R1 is exhibiting, however the eviction letter has been rescinded.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

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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Control Number 27-AS-20201012142344

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
	VISIT DATE: 02/25/2021

NARRATIVE

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The facility continues to work with R1 in recovery of the unpaid funds and the behavior challenges. R1 still resides at the facility and has had the needs and service plan updated to address the behavior challenges.

Based on interviews and records reviewed, the Department (CCLD) has found the allegation of Illegal eviction. Unsubstantiated.

A finding that the complaint allegation(s) is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted with Administrator Katrice Collins via telephone and a copy of 9099 and 811(Confidential Names) was provided to Katrice via email, an electronic email read receipt confirms receiving these documents. Administrator will sign 9099, and send back electronic email to LPA Johnson on today's date.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

LIC9099 (FAS) - (06/04)

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