392700368-6-19-2023-27-AS-KHOS-CT7PVS-20230627113938

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700368
Report Date: 06/14/2023
Date Signed: 06/19/2023 10:54:03 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
05/19/2023 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230519102450

FACILITY NAME:	COMMONS ON THORNTON, THE		FACILITY NUMBER:	392700368
ADMINISTRATOR:	ARBIOS, MARIE		FACILITY TYPE:	740
ADDRESS:	10711 THORNTON RD		TELEPHONE:	(209) 476-1500
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	110	CENSUS: 91	DATE:	06/14/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	ARBIOS, MARIE		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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9

Staff is mishandling the residents medication
Staff behavior poses as a risk to the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver findings for the allegations listed above. LPA was greeted by Executive Director and explained the reason for the visit.

Based on information gathered from R1 and R2'S files, doctors reports and interviews R1 and R2 are both able to administer their own medication.

Due to the information gathered LPA finds allegation to be UNFOUNDED. The allegation is UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. copy of report given.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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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