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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700611
Report Date: 09/05/2025
Date Signed: 09/09/2025 04:38:54 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
06/18/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250618141415
FACILITY NAME:QURESHI CARE HOMEFACILITY NUMBER:
392700611
ADMINISTRATOR:UMER QURESHI, MUHAMMADFACILITY TYPE:
735
ADDRESS:9555 PRISCILLA LANETELEPHONE:
(209) 565-5258
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:5CENSUS: 3DATE:
09/05/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Muhammad Ali QureshiTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee is allowing uncleared staff to work at the facility

Licensee does not ensure staff records are maintained on the premises

Staff are not dispensing medications as prescribed.
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 09/05/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff person, Cintia Perez, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator that CCL was present at this time for a complaint visit.
The facility designated Administrator, Muhammad Al Qureshi, arrived shortly thereafter to this facility while this LPA was conducting this visit.
Current census was 3 residents.
The purpose of this visit was to inform this facility, and its representative, that the investigation had been completed and to present the findings at this time.
Based on interviews conducted during the course of this investigation, it was learned that this facility is a Level 6 vendorized care home. This facility is able to accept and retain up to (4) Level 6 residents at any given time.
Based on a review of the forms and documents conducted during the course of this investigation, it was
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
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 2
Control Number 27-AS-20250618141415
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: QURESHI CARE HOME
FACILITY NUMBER: 392700611
VISIT DATE: 09/05/2025
NARRATIVE
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learned that a review was conducted for (5) facility staff persons at this time.
It was observed that all (5) facility staff persons were properly fingerprint cleared and properly associated to this facility at this time.
It was learned that all of the facility staff persons records were complete and contained all of the required forms and documents at this time.
A review of all (3) facility resident records was conducted. It was observed all (3) facility resident records were complete and were not missing any forms and documents at this time.
Based on a review and audit of the facility Medication Administration Records for all (3) facility residents, it was learned that the policies and procedures for proper medication management were being followed and upheld by the facility staff at this time. It was observed that the handling, dispensing, documentation of the facility resident medications were being maintained by the facility staff at this time.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred.

There were no deficiencies observed or cited at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2