392700527-3-28-2024-27-AS-LKIG-D46KY3-20240409081826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 02/29/2024
Date Signed: 03/28/2024 06:22:39 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
12/18/2023 and conducted by Evaluator Liza King

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231218154622

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:	DATE:	02/29/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Judy Rodrigues		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff stealing residents' medication
Staff are not properly trained.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Report amended to mark public
LPM Liza King and LPA Avelina Martinez arrived at the facility today to follow up on this complaint invesitgation. LPM and LPA met with Admin Judy Rodrigues and explained the purpose of the visit.

LPM requested MARs for R1 for the months of Oct, Nov and Dec2023. The only month that was filed in the DC file was July 2023. There was no Narcotic Log (NL) in the DC file provided or available for review.
LPM reviewed NL for five Residents residing in the Memory Care area and interviewed the Ast Admin Daisy Aguillar on the NL process. During review of the NL on this day, it did not appear that any medications were missing and the facility has a process in place. Based on the information provided during interviews and a review of documentation, there was insufficient information to conclude that staff had stolen narcotics.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Krystall Moore	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 27-AS-20231218154622

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 LODI	FACILITY NUMBER: 392700527
	VISIT DATE: 02/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPM King interviewed the Admin whom reported that all MedTechs (MT) have received their annual training. Training documents were not available as a result of the Change of Management. LPM interviewed 2 MT during the visit on this date, both of whom reported that they receive training regularly. Additionally on this date the facility was cited competency of MTs, since training is reported as being up to date see complaint and citations re complaint:27-AS-20240117144413 .

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.

SUPERVISOR'S NAME: Krystall Moore	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2