392700551-6-23-2021-27-AS-LKIG-C4FLTA-20210629090157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700551
Report Date: 06/23/2021
Date Signed: 06/23/2021 02:34:05 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
04/01/2021 and conducted by Evaluator Ashley Boothe

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210401150539

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:	06/23/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Alma Whitted		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff is harassing resident
Staff has not updated resident's emergency contact information.
Facility is not meeting resident's transportation needs.

INVESTIGATION FINDINGS:

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On 06/23/2021 at 11:30am, Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a complaint investigation with the following allegations: staff is harassing resident, Staff has not updated resident's emergency contact information and facility is not meeting resident's transportation needs. 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. Resident one (R1), Resident two (R2) and Resident three (R3) all currently have an updated emergency contact information on file. R3 makes changes to emergency contact information and it was found to be updated by staff.

Continued on 9099.

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: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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-20210401150539

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: 06/23/2021

NARRATIVE

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Continued on 9099.

The facility bus was broken for about 6 weeks time. The facility made reasonable accommodations to provide residents transportation using alternative methods including dial-a-ride, uber, taxis, and van go. The facility assumed responsibility for paying for transportation to and from medical appointments. R3 is unable to leave unassisted was provided transport to two appointments, one by facility staff and the other by responsible party during the time the bus was not working.

Based on statements made there were no known incidents reported of staff speaking inappropriately or harassing residents. R1 stated no incidents. R2 and R3 make complaints to staff and staff are trained to respond appropriately to meet resident needs and changes of condition. R3 baseline behaviors to make false accusations.

It was determined in the course of the investigation based on the information provided through documentation and interview, the aforementioned allegations staff is harassing resident, staff has not updated resident's emergency contact information and facility is not meeting resident's transportation needs are unfounded. This agency has investigated the complaint alleging facility and we have found the allegations false.

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: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC9099 (FAS) - (06/04)

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