392700527-12-4-2023-27-AS-LKIG-CYALLK-20231207075117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 12/04/2023
Date Signed: 12/04/2023 03:45:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/27/2023 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231027091740

FACILITY NAME:	A1 DEL MONTE ASSISTED LIVING LODI		FACILITY NUMBER:	392700527
ADMINISTRATOR:	SAINI, ANURADHA		FACILITY TYPE:	740
ADDRESS:	1321 S FAIRMONT AVENUE		TELEPHONE:	(209) 334-3436
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	145	CENSUS: 66	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Neil Mehta		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Uncleared individuals residing in facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 12/04/2023 at 9:00 AM to deliver complaint findings, LPA Martinez met with Anuradha Saini, Neil Mehta, and Stephen Ratlift and explained the purpose of the visit.

Throughout the course of the investigation, LPA Martinez conducted: interviews, reviewed files, toured the facility, and inspected rooms 44 and 70. LPA observed both rooms to be furnished. However, staff belongings were not stored in rooms 44 and 70. LPA Martinez was informed by Administrator, Anuradha Saini, that staff are not residing in rooms 44 and 70 at this time. The Administrator, Anuradha Saini, reported two staff were residing at the facility in the past. It was learned the two staff residing in rooms 44 and 70 are fingerprint cleared. Due to the above noted information, 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, and therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (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.

LIC9099 (FAS) - (06/04)

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