392700306-8-13-2024-27-AS-KHOS-D9DJ64-20240923064544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 08/13/2024
Date Signed: 08/13/2024 02:39:58 PM

Unsubstantiated

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
07/01/2024 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240701151041

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:	03:00 PM

ALLEGATION(S):

1
2
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8
9

Staff do not distribute residents' medications as prescribed
Staff do not ensure that skilled professionals take a resident's blood pressure

INVESTIGATION FINDINGS:

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2
3
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5
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7
8
9
10
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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.

Based on the information gathered, from records reviewd and interviews with the reporting party (R1) and facility staff S1-S2 the allegations that facility Staff do not distribute residents' medications as prescribed and
Staff do not ensure that skilled professionals take a resident's blood pressure are UNSUBSTANTIATED.

R1'S MAR'S were reviewed and based on information from R1 they are correct. Facility staff records were reviewed and all staff that handle medication have required training in place. Note that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegations are unsubstantiated.

An exit interview was held and a copy of this report was given.

Unsubstantiated

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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