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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 03/08/2022
Date Signed: 03/08/2022 04:11:03 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
02/03/2022 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20220203132627
FACILITY NAME:A1 DEL MONTE STOCKTONFACILITY NUMBER:
392700993
ADMINISTRATOR:SAINI, ANURADHAFACILITY TYPE:
740
ADDRESS:517 E. FULTON STREETTELEPHONE:
(209) 910-5910
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:158CENSUS: 98DATE:
03/08/2022
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Jenna SilvaTIME COMPLETED:
11:21 PM
ALLEGATION(S):
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9
Resident not accorded privacy while in care



INVESTIGATION FINDINGS:
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On 3-8-22 at 9:29am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue a complaint investigation for the allegation noted above. LPA met with Regional Executive Director Jenna Silva and explained the purpose of the visit. Administrator Anuraha Saini was notified and gave permission for Jenna to accommodate LPA and sign in her absence. On 2-16-22, LPA interviewed staff1 (S1) and S2. On 3-8-22, LPA interviewed resident2 (R2), R3, R4, and R5. LPA also interviewed regional executive director on 2-9-22. A facility observation was conducted by LPA on 3-8-22. Based on the interviews conducted and facility observation, it was determined that there have been no reports of staff or outside individuals entering or attempting to enter resident rooms without permission. Current procedures of knocking on residents’ doors and waiting ample time for a response are reportedly followed based on the interviews and observation conducted. Staff training on resident personal rights is conducted as part of regular staff training. Based on interviews, observation and record review it is determined that there is not a preponderance of evidence to prove resident privacy rights are being violated, therefore, this allegation is UNSUBSTANTIATED.
An exit interview was conducted with Jenna Silva and a copy of this report was given to Jenna.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
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
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
02/03/2022 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20220203132627

FACILITY NAME:A1 DEL MONTE STOCKTONFACILITY NUMBER:
392700993
ADMINISTRATOR:SAINI, ANURADHAFACILITY TYPE:
740
ADDRESS:517 E. FULTON STREETTELEPHONE:
(209) 910-5910
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:158CENSUS: 98DATE:
03/08/2022
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Jenna SilvaTIME COMPLETED:
11:21 PM
ALLEGATION(S):
1
2
3
4
5
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8
9
Resident was not provided services that they paid for
INVESTIGATION FINDINGS:
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On 3-8-22 at 9:28am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue a complaint investigation for the allegation noted above. LPA met with Regional Executive Director Jenna Silva and explained the purpose of the visit. Administrator Anuradha Saini was notified and gave permission for Jenna Silva to accommodate LPA and sign in her absence. On 2-9-22, LPA reviewed admission agreement and interviewed Administrator. On 2-16-22, LPA interviewed S1 and S2. LPA also conducted facility observation on 3-8-22. This complaint alleges that resident1 (R1) paid for access to television and was denied access to a television. Admission agreement reviewed by LPA and signed by R1 does not indicate facility will provide television in R1’s room but will provide maintenance as necessary. An interview with R1 on 2-9-22 revealed that R1 has her own private television which was not in working prior to LPAs visit on 2-9-22, but was repaired in a reasonable time frame, and was in working order on 2-9-22 and currently in working order as of 3-8-22. Additionally, facility observation revealed that R1 and other residents in care have access to a working television located in the main dining room. {Cont. on 9099C}
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20220203132627
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: A1 DEL MONTE STOCKTON
FACILITY NUMBER: 392700993
VISIT DATE: 03/08/2022
NARRATIVE
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Based on the interviews, record reviews, and observation conducted, it is determined that R1 has reasonable access to a television and the residency fee paid does not include an individual television provided in R1’s room per admission agreement. As a result, the preponderance of evidence standard is not met, therefore, this allegation is UNFOUNDED.

An exit interview was conducted with Jenna Silva and a copy of this report was given to Jenna
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3