392700361-6-20-2022-27-AS-KHOS-CFKLK5-20220620084858

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700361
Report Date: 06/17/2022
Date Signed: 06/20/2022 08:46:57 AM

Unsubstantiated

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
04/04/2022 and conducted by Evaluator Michael Bilger

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220404162755

FACILITY NAME:	STACIE'S CHALET STOCKTON		FACILITY NUMBER:	392700361
ADMINISTRATOR:	ANURADHA SAINI		FACILITY TYPE:	740
ADDRESS:	517 E FULTON ST		TELEPHONE:	(209) 910-5910
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY:	0	CENSUS: 0	DATE:	06/17/2022
		UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	Mailed to Previous Licensee		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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Facility Overcharged Resident

INVESTIGATION FINDINGS:

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On 6-17-22 at 8:48am, Licensing Program Analyst (LPA) Michael Bilger completed complaint investigation for the allegation noted above. Facility has been closed since 7-1-21 and complaint allegation was received on 4-4-22. LPA conducted interviews with complainant and staff1 (S1), and reviewed previous charting notes for R1. LPA also attempted to review record for resident1 (R1). LPA additionally reviewed financial documents pertaining to R1 and facility documentation pertaining to R1’s care and residency status. Based on record reviews it was determined that a financial statement submitted by R1’s conservator’s office states facility was paid the sum of $1,069.37 on March and April of 2021 in which time R1 was not residing in the facility. Additional review of financial documentation does not include proof of cashed checks by facility for R1’s residency. Additional financial documents for R1 were not included in R1’s chart. As a result, there is not a preponderance of evidence to prove that facility overcharged and received additional money during the periods of March to June of 2021. Therefore this allegation is UNSUBSTANTIATED.

A copy of this report will be mailed to previous licensee with request for return with signature.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022

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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