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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 06/10/2022
Date Signed: 06/10/2022 04:39:49 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
06/08/2022 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20220608144500
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: 86DATE:
06/10/2022
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Lakhbir Kaur, Director of NursingTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent an outbreak of illness
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6-10-22 at 10:05am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate a complaint regarding the allegation noted above. LPA met with Director of Nursing (DON) Lakhbir Kaur, LVN and explained the purpose of the visit. LPA also spoke with Administrator Anuradha Saini via phone and explained the purpose of the visit and discussed the above allegations. During this investigation, LPA interviewed Resident1 (R1), R2, and R3. LPA also interviewed Administrator, DON, Staff1 (S1), S2, and S3. LPA also requested staffing roster, resident roster, and conducted a facility observation. LPA also reviewed facility file documentation for R4, R5, R6, and R7.
Based on interviews and record reviews it was determined that R4, R5, R6, and R7 experienced symptoms of flu resulting in a suspected outbreak of flu. It was further determined through interviews, record reviews, and facility observation on 6-10-22 that appropriate precautions were put in place to address the suspected outbreak upon discovery including isolation procedures, alternative meal service procedures, ensuring handwashing, and social distancing practices. {Cont on 9099C}
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: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
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 4
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
06/08/2022 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20220608144500

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: 86DATE:
06/10/2022
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Lakhbir Kaur, Director of NursingTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not maintain a comfortable temperature in the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6-10-22 at 10:05am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate a complaint regarding the allegation noted above. LPA met with Director of Nursing (DON) Lakhbir Kaur, LVN and explained the purpose of the visit. LPA also spoke with Administrator Anuradha Saini via phone and explained the purpose of the visit and discussed the above allegations. During this investigation, LPA interviewed Resident1 (R1), R2, and R3. LPA also interviewed Administrator, DON, Staff1 (S1), S2, and S3. LPA also requested staffing roster, resident roster, and conducted a facility observation. Based on interviews and facility observation, it was determined that facility temperature has been maintained between 65*F and 85*F within regulatory requirements within the last 2 weeks timeframe. Additionally, it was determined through interviews and facility observations that alternative methods are in place in the event of air conditioning unit malfunction including individual fan availability and portable units to ensure adequate facility temperature.
Based on interviews and observations conducted, it is determined that this allegation is UNFOUNDED.

An exit interview was conducted with Lakhbir Kaur, and a copy of this report was left with Kakhbir.
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: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
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 4
Control Number 27-AS-20220608144500
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: 06/10/2022
NARRATIVE
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31
32
 Testing was performed to rule out additional cases of suspected flu outbreak. As a result, there is a not a preponderance of evidence to prove facility did not prevent an outbreak of illness, therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Lakhbir Kaur, and a copy of this report was left with Lakhbir.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4