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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700527
Report Date: 12/04/2023
Date Signed: 12/04/2023 04:21:42 PM


Document Has Been Signed on 12/04/2023 04:21 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:A1 DEL MONTE ASSISTED LIVING LODIFACILITY NUMBER:
392700527
ADMINISTRATOR:SAINI, ANURADHAFACILITY TYPE:
740
ADDRESS:1321 S FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:145CENSUS: DATE:
12/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Neil Mehta TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Avelina Martinez arrived at this facility unannounced on 12/04/2023 at 9:00 AM to conduct a case management visit. LPA Martinez met with Anuradha Saini, Neil Mehta, and Stephen Ratlift and explained the purpose of the visit.

The purpose of the visit today is to follow up on two resident transfers from A1 Del Monte Assisted Living Stockton. LPA Martinez reviewed resident 1 (R1) and resident 2 (R2) medical file. R1 and R2's files have not been updated. R1 and R2's files/documentation indicated Del Monte Assisted Living & Memory Care Stockton. In addition, R2 will require an updated admission agreement. R1 and R2's LIC 602 Physician Report need to be updated, and Section 1 Facility Information states Del Monte Assisted Living Stockton.

Moreover, it was learned R1 and R2 arrived at A1 Del Monte Assisted Living Lodi on 12/01/2023. All of R1 and R2's belongings have not been transferred to A1 Del Monte Assisted Living Lodi. LPA Martinez was informed R1 and R2 require a higher level of care and are not an appropriate fit for A1 Del Monte Assisted Living Lodi facility. In addition, it was learned R1 and R2 have not been reassessed. At this time, this case management requires additional information. LPA Martinez will return at a later date to follow up on this case management.

An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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