392700551-8-16-2021-27-AS-LKIG-C72V52-20210920160712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700551
Report Date: 08/16/2021
Date Signed: 08/16/2021 04:31:15 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
06/25/2021 and conducted by Evaluator Ashley Boothe

COMPLAINT CONTROL NUMBER: 27-AS-20210625152618

FACILITY NAME:	CAMLU ASSISTED LIVING		FACILITY NUMBER:	392700551
ADMINISTRATOR:	WHITTED, ALMA		FACILITY TYPE:	740
ADDRESS:	6037 N PERSHING AVE		TELEPHONE:	(209) 951-2030
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	96	CENSUS: 60	DATE:	08/16/2021
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Alma Whitted		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff will not give resident juice at night

INVESTIGATION FINDINGS:

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On 08/16/2021 at 12:15pm, Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a complaint investigation with the following allegations: Staff will not give resident juice at night. LPA met with Administrator and explained the purpose of today’s visit. LPA was allowed entry into the facility, current census is 60.

During the course of the investigation LPA reviewed records, conducted interviews and on site inspection. LPA observed supplies of juice and crackers stored in the medications room for use when resident's sugar levels are too low. Interviews concluded esidents have access to juice during meal times and can take juice back to their room to drink later. Residents go to the store to purchase thier own food supplies or residents responsible parties bring supplies to stock refrigerators in residents' rooms. Resident one (R1) experienced an incident of requested juice and staff did not provided but it was unclear if R1 requested juice due to the symptoms of sugar levels too low or they did not have juice stored in thier room at the time.
Continued on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

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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Control Number 27-AS-20210625152618

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: 08/16/2021

NARRATIVE

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Continued from 9099.

It was determined in the course of the investigation based on the information provided through documentation and interview, the aforementioned allegation staff will not give resident juice at night are unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Per the California Code of Regulations, Title 22, Division 6, no deficiencies observed or cited. Exit interview held, copy of report given.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

LIC9099 (FAS) - (06/04)

Page: 2 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
06/25/2021 and conducted by Evaluator Ashley Boothe

COMPLAINT CONTROL NUMBER: 27-AS-20210625152618

FACILITY NAME:	CAMLU ASSISTED LIVING		FACILITY NUMBER:	392700551
ADMINISTRATOR:	WHITTED, ALMA		FACILITY TYPE:	740
ADDRESS:	6037 N PERSHING AVE		TELEPHONE:	(209) 951-2030
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	96	CENSUS: 60	DATE:	08/16/2021
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Alma Whitted		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff do not treat resident with respect

INVESTIGATION FINDINGS:

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On 08/16/2021 at 12:15pm, Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a complaint investigation with the following allegations:Staff do not treat resident with respect. LPA met with Administrator and explained the purpose of today’s visit. LPA was allowed entry into the facility, current census is 60.

During the course of the investigation LPA reviewed records, conducted interviews and on site inspection.
Based on statements made there were no known incidents reported of staff speaking inappropriately to residents. Residents interviewed stated no complaints. R1's baseline behavior is to make false accusations. Staff are trained to respond appropriately to meet resident needs.

It was determined in the course of the investigation based on the information provided through documentation and interview, the aforementioned allegations are unfounded. This agency has investigated the complaint alleging facility and we have found the allegations false.

Per the CCCR, Title 22 no deficiencies cited. Exit interview, copy of report

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

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

LIC9099 (FAS) - (06/04)

Page: 3 of 3