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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700551
Report Date: 09/11/2020
Date Signed: 09/11/2020 02:14:59 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/16/2020 and conducted by Evaluator Tuyet-Suong Teh
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20200616135657
FACILITY NAME:CAMLU ASSISTED LIVINGFACILITY NUMBER:
392700551
ADMINISTRATOR:WHITTED, ALMAFACILITY TYPE:
740
ADDRESS:6037 N PERSHING AVETELEPHONE:
(209) 951-2030
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:96CENSUS: 69DATE:
09/11/2020
UNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Alma WhittedTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Resident wandered away from the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Suong Teh contacted the facility administrator Alma Whitted via telephone to commence a complaint investigation via telephone due to COVID-19 and pre-cautionary measures. The purpose of this visit was to deliver findings for this complaint investigation.

On 09/04/2020, LPA first attempted to contact witness #1 (W1). There were two additional attempted calls to W1 and were not able to reach W1. 09/04/2020 LPA called and left a message for witness #2 (W2) to call LPA. LPA spoke to the facility administrator Alma Whitted on 09/01/2020 and she confirmed that there was no AWOL incident occurred on Sunday 06/14/2020. Staff #2 (S2) and staff #3 (S3) verified that they were on duty on 06/14/2020 and confirmed that no resident AWOL that day.

Due to the information gathered, allegation resident wandered away from the facility is found to be 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.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/16/2020 and conducted by Evaluator Tuyet-Suong Teh
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20200616135657

FACILITY NAME:CAMLU ASSISTED LIVINGFACILITY NUMBER:
392700551
ADMINISTRATOR:WHITTED, ALMAFACILITY TYPE:
740
ADDRESS:6037 N PERSHING AVETELEPHONE:
(209) 951-2030
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:96CENSUS: 69DATE:
09/11/2020
UNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Alma WhittedTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's needs are not being met.
Facility is not kept clean.
Facility is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
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5
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7
8
9
10
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12
13
Based on interviews and virtual visits on 06/17/2020, 09/02/2020 and 09/03/2020 of 14 resident rooms. LPAs observed all 14 resident rooms including the bathrooms to be cleaned and all windows were operable. LPA Teh spoke to 8 residents and 7 residents stated that their needs have been met except 1 resident stated that she wanted to move out.

Based on interviews conducted and observations, the complaint allegations Resident's needs are not being met, Facility is not kept clean and Facility is in disrepair are UNSUBTANTIATED. A finding that the complaint allegation(s) is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.
There were no deficiencies cited on today’s date.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20200616135657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CAMLU ASSISTED LIVING
FACILITY NUMBER: 392700551
VISIT DATE: 09/11/2020
NARRATIVE
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An exit interview was conducted with via telephone and a copy of 9099, 9099-C's, Appeal Rights, and 811(Confidential Names) was provided to the facility administrator Alma Whitted via email, an electronic email read receipt confirms receiving these documents. The licensee will sign 9099, 9099-C's and send back electronic email to LPA Teh on today's date 09/11/2020.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3