392700644-8-27-2023-27-AS-KHOS-CWJJTL-20231012072007

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700644
Report Date: 08/17/2023
Date Signed: 08/27/2023 08:47:25 PM

Unsubstantiated

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
08/01/2023 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230801114146

FACILITY NAME:	SUMMERFIELD OF STOCKTON		FACILITY NUMBER:	392700644
ADMINISTRATOR:	ANDERSON, LESLIE		FACILITY TYPE:	740
ADDRESS:	3530 DEER PARK DRIVE		TELEPHONE:	(209) 951-6500
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95219
CAPACITY:	60	CENSUS: 53	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	L. Anderson		TIME COMPLETED:	11:57 AM

ALLEGATION(S):

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Staff not providing adequate supervision to residents in care.
Staff did not provide medical attention in a timely manner.
Resident was left in soiled diaper for an extended amount of time.

INVESTIGATION FINDINGS:

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Allegation: Staff not providing adequate supervision to residents in care. Based on interviews with the Staff present that day and the Administrator, the department discovered that R1 was not out of the building, R1 was sleeping in another residents room. R1 left the activities group and went into another residents room, laid down resting when staff located her. According to the records reviewed and statements given, R1 was never lost, however she was not in her room and her assigned companion was having trouble locating R1 until a staff member overheard the concern and pointed out the location of R1. The time frame was roughly 15 minutes from the time the question about the location of R1 and the time R1 was secured with her companion.

Allegation: Staff did not provide medical attention in a timely manner. Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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-20230801114146

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: SUMMERFIELD OF STOCKTON	FACILITY NUMBER: 392700644
	VISIT DATE: 08/17/2023

NARRATIVE

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R2 had just been taken back from the living room to her bedroom, by her son, who was visiting, and one of Summerfield's caregivers, at around 10:10 am. R2 was tired and asked to take a nap. The Summerfield caregiver and son laid her on her side in bed. Hansel came back to check on R2 at approximately 10:15 and the Home Health nurse arrived at 10:30 and that is when she tried to wake up R2 and said she is unresponsive.

At 10:30am Home Health RN had just come to check up on R2 because she had a fall on 07/31/2023 and Home Health was ordered for follow up care. The nurse told Hansel who was in the hallway that R2 needed to be checked and she was unresponsive. 911 was immediately called and the medics arrived. When the Medics left her R2 was awake and responsive to the Paramedics. She was taken to St. Joseph's Hospital. Home Health RN and Hansel LVN from Summerfield attended to R2 immediately when they noticed a change of condition and they called 911.

Allegation: Resident was left in soiled diaper for an extended amount of time.

Based on interviews conducted, R1 spends every morning in the Activity Room doing her exercises. Dixen, the Activity Director, said she had left as soon as exercise was done. She does get tired and wants to lay down. R1 went to the first open room door she could find and laid down on one of the beds with the door still open. She had gone to Activities at 9:00am and then laid down around 9:50 right after she left Activities, she was woken up at 10:30.

As a result of this investigation, this Department finds the allegations to be UNSUBSTANTIATED. A complaint allegation finding of 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 occurred.

Exit interview was conducted with Administrator

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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