392700361-10-12-2020-27-AS-LKIG-BUCQV3-20201013122938

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700361
Report Date: 10/12/2020
Date Signed: 10/12/2020 02:26:12 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
06/04/2020 and conducted by Evaluator Diego Escobar

COMPLAINT CONTROL NUMBER: 27-AS-20200604143202

FACILITY NAME:	STACIE'S CHALET STOCKTON		FACILITY NUMBER:	392700361
ADMINISTRATOR:	PETERSON-WORLEY, ALESIA		FACILITY TYPE:	740
ADDRESS:	517 E FULTON ST		TELEPHONE:	(209) 466-2116
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY:	114	CENSUS: 81	DATE:	10/12/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jade Parker, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff Stealing Narcotics

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Diego Escobar made a subsequent investigation televisit on 10/12/2020 to deliver the allegation findings. LPA spoke to Jade Parker, Administrator, and explained the purpose of the call.

LPA interviewed Administrator, six staff members (S1, S2, S3, S4, S5, S6). LPA reviewed the facility medication files of two residents, (R1, R2), who's medication was allegedly stolen. LPA was given a majority of statements that do not support the allegation listed above. Facility documents reviewed do not indicate medication was stolen. No supporting evidence was provided to LPA that show staff members stole medication.

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: 10/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020

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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