392700306-4-21-2021-27-AS-SRIN-C2CLP7-20210423085524

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 04/21/2021
Date Signed: 04/21/2021 12:42:20 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
12/29/2020 and conducted by Evaluator Ruth Wallace

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20201229172724

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: 66	DATE:	04/21/2021
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Telephone - Administrator Katrice Collins Due to Precautions for COVID-19		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff tampered with resident's mail.
Staff did not ensure resident received wound bandages.
Staff left resident unattended in a shower.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Wallace contacted the facility via telephone to conclude a complaint investigation due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the allegations with the Administrator.

Based on LPA interviews with R1, staff, administrator, residents, R1's social worker, and ombudsman; the facility
has a policy in place and every resident has a copy of it. Mail can be opened if prescriptions are suspected for
the safety of all residents. The allegation that staff tampered with resident's mail has occurred, but the Medication Technicians (MT's) are following the guidelines of facility policy and Title 22 Regulations to ensure the safety for all residents in regard to prescriptions. The prescriptions must be locked up and ordered by a physician; therefore the allegation is deemed UNFOUNDED. This agency has investigated the allegation noted above and have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. We have therefore, dismissed the complaint.
Continued on 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021

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-20201229172724

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: 04/21/2021

NARRATIVE

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Continued from 9099 - Page 2

Based on LPA interviews with R1, staff, administrator, residents, R1's social worker, and ombudsman; the staff
did ensure resident received wound bandages. R1 goes to his appointments for wound care on a regular basis
which are outside of the facility. Bandages are prescribed by physician, therefore bandages are locked up in
medication room. LPA found no evidence of the allegation that staff did not ensure resident received wound
bandages; therefore the allegation is deemed UNFOUNDED. This agency has investigated the allegation noted
above and have found that the complaint was unfounded, meaning that the allegation was false, could not have
happened and/or was without a reasonable basis. We have therefore, dismissed the complaint.

Based on LPA interviews with R1, staff, administrator, residents, R1's social worker, and ombudsman; the staff have left resident (R1) unattended in a shower after R1 has made inappropriate sexual comments to staff, or inappropriate touching of staff, or touching himself asking staff to watch. R1 has also been intoxicated at times, therefore behaviors have created an uncomfortable environment for staff or residents near R1's room. LPA has evidence that R1's behaviors and actions have created situations where staff do leave R1 in the shower alone. Staff wait right outside of shower until he is finished making inappropriate comments or gestures. The allegation that staff left resident unattended in shower has occurred, but the staff are allowed respect and dignity while performing their duties in facility or with residents; therefore the allegation is deemed UNFOUNDED.

An exit interview was conducted with Administrator via telephone and a copy of this report LIC 9099, LIC 9099-C, LIC 858- Client Records, LIC 811- Confidential Names, and Appeal Rights was provided to the Administrator via email and an electronic email read receipt confirms receiving these documents. Administrator will send 9099 and 9099-C back via email signed to LPA Wallace.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021

LIC9099 (FAS) - (06/04)

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