392700361-11-25-2020-27-AS-KHOS-BVVNCL-20201201092054

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700361
Report Date: 11/25/2020
Date Signed: 11/25/2020 03:08:44 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
08/07/2020 and conducted by Evaluator Diego Escobar

COMPLAINT CONTROL NUMBER: 27-AS-20200807130709

FACILITY NAME:	STACIE'S CHALET STOCKTON		FACILITY NUMBER:	392700361
ADMINISTRATOR:	RIDOLFI, ELEINA		FACILITY TYPE:	740
ADDRESS:	517 E FULTON ST		TELEPHONE:	(209) 466-2116
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY:	114	CENSUS: 78	DATE:	11/25/2020
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Jade Parker, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Not enough snacks for residents in care
Facility air conditioner in disrepair
Residents not receiving medications on time due to lack of staff
Residents blood sugar strips not reordered timely

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Diego Escobar made a subsequent investigation televisit on 11/25/2020 to deliver the allegation findings. LPA spoke to Jade Parker, Administrator, and explained the purpose of the call.

LPA interviewed Administrator, residents, and staff members. The Department was not given enough allegation details. Through interviews and record review, the Department could not find evidence to support that the allegations listed above. 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, therefore the allegations are Unsubstantiated.

Exit interview was conducted with Administrator. Copy of the report sent to Jade Parker via e-mail with a "read receipt" to verify the LIC 9099 was received. Jade is to print out each report, and fax a signed copy to LPA at 916-263-4744.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) -26-4752
LICENSING EVALUATOR NAME: Diego Escobar	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020

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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