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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
392700306
Report Date:
08/13/2024
Date Signed:
08/13/2024 02:35:41 PM
Unfounded
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
08/12/2024
and conducted by Evaluator
Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER:
27-AS-20240812112738
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:
69
DATE:
08/13/2024
UNANNOUNCED
TIME BEGAN:
01:30 PM
MET WITH:
MANISHA PUNNI
TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal rights
Staff did not report incident to resident's responsible party
Licensee does not provide a resident and responsible party with a reappraisal meeting
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 open an complaint for the above allegations. LPA was greeted by Executive Director and explained the reason for the visit.
LPA leaned during the visit that R1 did not reside at this facility but at a skilled nursing facility that is located on the same property. No investigation done. Allegation is unfounded.
An exit interview was held and a copy of this report was given.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME:
Liza King
TELEPHONE:
(650) 676-0442
LICENSING EVALUATOR NAME:
Kesha Lewis
TELEPHONE:
(916) 764-1024
LICENSING EVALUATOR SIGNATURE:
DATE:
08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/13/2024
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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