392700368-9-19-2020-27-AS-LKIG-BTWRPQ-20200929131219

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700368
Report Date: 09/19/2020
Date Signed: 09/19/2020 11:15:45 AM

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
06/03/2020 and conducted by Evaluator Ruth Wallace

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200603091534

FACILITY NAME:	COMMONS ON THORNTON, THE		FACILITY NUMBER:	392700368
ADMINISTRATOR:	MILLER, CAROL		FACILITY TYPE:	740
ADDRESS:	10711 THORNTON RD		TELEPHONE:	(949) 242-1400
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	110	CENSUS: 93	DATE:	09/19/2020
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Telephone Call Due To Pre-Cautionary Measures of COVID-19/Administrator Carol Miller		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Staff touched resident in an inappropriate manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Wallace contacted Administrator Carol Miller on this day to conclude a complaint investigation via telephone due to COVID-19 and pre-cautionary measures. An initial Priority 2 10 Day Complaint visit was conducted on June 4, 2020.
Allegation: Staff touched resident in an inappropriate manner.
A physical visit was not conducted in that the Department is not conducting Residential Care for the Elderly visits at this time, due to the COVID-19 virus.

During the investigation, the Department conducted Interviews with the Complainant, Administrator, three staff, Ombudsman, Stockton Police Department-Detectives, Victim, Witness, and Suspect.
LPA Wallace obtained Medical Records, Physician's Report, Admission's Agreement, Needs and Services Plan from facility to conduct investigation.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2020

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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Control Number 27-AS-20200603091534

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: COMMONS ON THORNTON, THE	FACILITY NUMBER: 392700368
	VISIT DATE: 09/19/2020

NARRATIVE

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Facility staff and suspect denied seeing or being involved in touching R1 in an inappropriate manner.

Based on the lack of evidence during interviews with all parties involved; LPA's observations and records reviews, there is not a preponderance of evidence to substantiate the allegation. The Department Community Care Licensing Division (CCLD) has found the allegation of Staff touching resident in an inappropriate manner. Unsubstantiated.

A finding that the complaint allegation(s) is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted with Administrator Carol Miller via telephone and a copy of this report was provided to Carol Miller via email and an electronic email read receipt confirms receiving these documents. Administrator will sign 9099 and return to LPA via email.

No deficiencies were cited.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2020

LIC9099 (FAS) - (06/04)

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