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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 02/23/2022
Date Signed: 02/23/2022 12:09:53 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: 93DATE:
02/23/2022
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Alicia CarranzaTIME COMPLETED:
11:47 AM
ALLEGATION(S):
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Resident rates increased without proper notification
INVESTIGATION FINDINGS:
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On 2-23-22 at 11:05am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegation noted above. LPA met with Alicia Carranza and explained the purpose of the visit. Administrator Anuradha Saini was notified and gave permission for Alicia Carranza to accommodate LPA and sign in her absence. During this investigation, LPA reviewed Admission agreement for Resident1 (R1), a general rate increase notice furnished by facility, interviewed R1, and interviewed regional executive director. Based on interviews and record review it was determined that the admission agreement for R1 contains a provision which states a 60-day notice will be given for a change in monthly fee. Review of general rate increase notice dated 10-1-21 revealed that the notice was not addressed to a specific resident and did not contain a signature of acknowledgement in order to determine proof of issuance. Additionally, this notice did not state an adequate reason for an increase or a general description of any additional costs as per regulatory requirements. Interview with R1 revealed a notice was issued on 1-24-22 to reflect an effective rate change date of 2-1-22. {Cont on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
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
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: 02/23/2022
NARRATIVE
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Based on interviews and record reviews it is determined that the preponderance of evidence standard has been met, therefore, this allegation is SUBSTANTIATED. Deficiencies are cited under Title 22, Health and Safety Code, chapter 3.2.

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

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2022
Section Cited
HSC
1569.655(a)
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Increase in fee rates for elderly residents...60 days' written notice..(a)If a licensee of a residential care facility for the elderly increases the rates of fees for residents...the licensee shall provide no less than 60 days' prior written notice to the residents
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Licensee has re-issued a revised 60-day notice with proper contents to R1 on 2-18-22 to reflect the new rate change on 5-1-22.

Licensee will read health and safety code 1569.655 and provide a signed certification of understanding to LPA by POC due date.
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 or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs. This requirement is not met as evidenced by: Based on record review and interviews Licensee did not ensure proper 60-day notification was given to R1 for a rate increase. This poses a potential resident rights risks to residents 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.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3