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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700580
Report Date: 09/17/2025
Date Signed: 09/17/2025 03:17:30 PM

Substantiated


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
09/02/2025 and conducted by Evaluator Noel Wolf Petersen
COMPLAINT CONTROL NUMBER: 27-AS-20250902130558
FACILITY NAME:WALTERS RESIDENTIAL HOME CARE 3FACILITY NUMBER:
392700580
ADMINISTRATOR:JOSEPH NIMENEFACILITY TYPE:
735
ADDRESS:1335 MINE STTELEPHONE:
(510) 688-3552
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:4CENSUS: 4DATE:
09/17/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Joseph NimeneTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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The facility did not safegaurd personal cash/property
INVESTIGATION FINDINGS:
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*This is an ammended report to change the finding from unfounded to substantiated, this is the most up to date 9099*
Licensing Program Analyst (LPA) Noel Wolf Petersen arrived unannounced on 9/9/25 to conduct a complaint investigation into the above allegation, Lpa explained the purpose of the visit to administrator Joseph Nimene by Phone and Tanneh Koayen staff in person.
LPA investigated the complaint by record review, interview, and observation. The P/I documentation for the residents was reviewed, 2 of 2 resident records showed, one record was not in agreement with cash but in the favor of the resident. Facility is occasionally gifting small amounts of money(sub5$) to the residents when they come up short at the end of the month and go on an outing where the last of the months monies are used. Technical violation was issued. The Recipts of the facilities food puchases for the previous 3 months were reviewed, in august 2164.46 was spent on groceries, 458.35 was spent on Fast food, which LPA estamates as accurate for having adequate food in the facility. September is on track to be similar. The facility's food at the time of the visit was observed by the LPA to be adequate for 2 days perishable, 7 days nonperishable, and 3 days emergency for 4 people.
continued on C page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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
Control Number 27-AS-20250902130558
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: WALTERS RESIDENTIAL HOME CARE 3
FACILITY NUMBER: 392700580
VISIT DATE: 09/17/2025
NARRATIVE
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*This document is amended to support a finding of substantiated instead of unfounded, a new report supercedes this one*
1 client interview, 3 staff interviews were conducted. The Concensus statement regarding safegaurded cash is that all monies spent on the residents behalf were for thier personal benefit, and not to the benefit of the facility or another resident.

In process of the investigation, LPA became aware of a seperate statement was made to VMRC by the resident in conflict with the statement made to the LPA, where the resident presented the monies as a necessary expense to cover basic services expenses for the facility. two reciepts were presented to the LPA for record review, showing not only a large amount of grocery purchases with duplicate and exccessive amounts of food for a single persons consumption, but a two containers of 56 oz fabulosa, which could not be logically construed as for the residents personal consumption. An interview with the VMRC service coordiator illuminated a possible motivation for the resident to end the investigation as quickly as possible, that the resident is legally embattled and would prefer his residency in the home to be made stable.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, is being cited on the attached LIC 9099D.

Appeal rights were provided. An exit interview was conducted, a copy of the report was read and given to the administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 27-AS-20250902130558
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: WALTERS RESIDENTIAL HOME CARE 3
FACILITY NUMBER: 392700580
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/17/2025
Section Cited
CCR
80026(f)
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents(f) The licensee or employee of a licensee shall not make expenditures from clients' cash resources for any basic services in these regulations... This requirement was not met as evidenced by:
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 No plan of correction. funds were repaid to the client.
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Record review of a reciept 8/1/25 reflecting that 2 bottles of 56 oz fabulosa were purchased with funds of a clients cash resources.
This poses a significant risk to to the personal rights of the clients in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3