<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 03/14/2024
Date Signed: 03/14/2024 02:14:37 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 Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20231218154622
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: 63DATE:
03/14/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Judy Rodriguez & Daisy AguilarTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility not adhering to resident's admission agreement.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/14/2024 at 9:00 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced to deliver complaint findings. LPA met with Judy Rodriguez & Daisy Aguilar during today’s visit and explained the purpose of today's visit.

Throughout the course of this investigation, LPA Martinez conducted interviews, reviewed facility records, and resident records. LPA Martinez requested to review resident 1's (R1) admission agreement. LPA Martinez was informed there was no admission agreement by staff 1 and staff 2. Staff 1 and staff 2 informed LPA Martinez to obtain a copy from A1 Del Monte Lodi Management Company. On February 29, 2024, LPA Martinez contacted A1 Del Monte Lodi Management Company and requested the following documents: admission agreement, basic rate billing statements, invoices, and outstanding balances.

Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
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: 03/14/2024
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
LPA Martinez was not provided R1's admission agreement from A1 Del Monte Lodi Management Group due to them not having access to facility files. LPA Martinez received a copy of R1's admission agreement on March, 08 2024. Please refer to case management report dated March 14, 2024 for deficiency 87755 Inspection Authority of the Licensing Agency. The deficiency cited is due to not having R1's records readily available to inspect, audit, and copy R1's facility records upon demand during normal business hours.

Additionally, LPA Martinez requested R1's 30-day move out notice. Facility staff 1 and staff 2 reported they were unaware of a 30-day move out notice and to follow up with A1 Del Monte Lodi Management Group. A1 Del Monte Lodi Management Group reported they did not have access to R1's file that contained a written 30-day notice. Also, There is no written documentation by facility staff that R1 did or did not provide a 30-day notice. Moreover, R1's signed admission agreement section 19: Termination of Agreement states, "You may terminate this agreement at any time with a 30 day written notice." However, There is no additional information regarding fees or charges for not providing a written 30-day move out notice. R1 was charged $ 3,700.00 due to not providing a 30-day notice to cover rental monthly fees. However, due lack of documentation there is not enough evidence to prove the facility is not following the admission agreement.

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: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2