392700306-1-23-2025-27-AS-LRIS-DE3TXN-20250220140726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700306
Report Date: 01/22/2025
Date Signed: 01/23/2025 08:00:37 AM

Substantiated

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
12/30/2024 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20241230131015

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:	DATE:	01/22/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	MANISHA PUNNI		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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8
9

Staff did not provide adequate assistance to resident in care
Staff spoke inappropriately resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver findings for the allegations. LPA was greeted by Executive Director and explained the reason for the visit.

Based on the information gathered, through interviews with Staff and residents,the allegations Staff did not provide adequate assistance to resident in care and Staff spoke inappropriately resident in care are SUBSTANTIATED.

Based on dinterviews with staff and residents is was learned that staff will respond to turn the call lights off but not assist the residents with therie needs. S1 was also terminated from the facility because they were speaking to residents in an inapproate manner. Based on observation and interview, the preponderance of evidence standard is met, and these allegations are SUBSTANTIATED.

Citations are issued as indicated on LIC 9099D. An exit interview was conducted Appeal rights provided.

Substantiated

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: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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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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
12/30/2024 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20241230131015

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:	DATE:	01/22/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	MANISHA PUNNI		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff mismanaged resident's medication

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 deliver findings for the 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 Staff and the R1,the allegations Staff mismanaged resident's medication, is UNSUBSTANTIATED.

Based on documents reviewed R1 has recieved all medication that was to be given to them unless refused by resident from November 2024 though theis vist on January 22nd 2025. 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: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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-20241230131015

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WAGNER HEIGHTS RESIDENTIAL	FACILITY NUMBER: 392700306
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/22/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/23/2025 Section Cited CCR 80072(a)(1)	1 2 3 4 5 6 7	80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated the staff fired from facility. No other POC needed.
	8 9 10 11 12 13 14	Based on records review, staff and residents heard S1 speaking to a resident inappropriately. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
Type B 01/23/2025 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	(f) (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing...	1 2 3 4 5 6 7	Administrator will review regulation and send a statement to LPA stating this has been completed and understood by COB on 01/23/2025, additionally call light policy training will be completed by all staff by 02/01/2025 COB.
	8 9 10 11 12 13 14	Based on interviews, staff are turning off call lights and not assisting residents with their needs. Which poses a immediate health, safety and/or personnel rights risk.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (916) 764-1024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC9099 (FAS) - (06/04)

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