392700366-8-5-2022-27-AS-SDOB-CHCPGT-20220816111851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700366
Report Date: 08/04/2022
Date Signed: 08/05/2022 02:50:35 PM

Substantiated

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
01/12/2022 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220112104530

FACILITY NAME:	COMMONS AT UNION RANCH, THE		FACILITY NUMBER:	392700366
ADMINISTRATOR:	DIANA BORZA		FACILITY TYPE:	740
ADDRESS:	2241 N UNION ROAD		TELEPHONE:	(209) 463-9100
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	135	CENSUS: 91	DATE:	08/04/2022
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Sherri Kimbro		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not responding to pull cords timely

Residents are not getting showers due to lack of staff

INVESTIGATION FINDINGS:

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Unannounced follow up complaint visit made out to this facility on 08/04/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administratory Sherri Kimbro.
Current census was 91 residents.
The purpose of this visit was to revise this LIC 9099 to reflect some changes that were made to the allegations listed above in this complaint investigation.

Even though the investigation was completed and the allegations were deemed to be SUBSTANTIATED, there won't be any deficiencies cited since they were already recorded on a previous complaint with the same allegations.

Exit Interview

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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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