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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 10/14/2022
Date Signed: 10/14/2022 04:32:34 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
08/18/2022 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20220818164143
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: 92DATE:
10/14/2022
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Anuradha SainiTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff failed to provide adequate food service
Staff are not taking precautions for COVID-19
Due to lack of supervision residents engaged in inappropriate interactions
Staff handle residents in a rough manner and yell at residents
Residents are left in soiled clothing
Facility is malodorous
Facility has an infestation of insects
Facility has an outbreak of scabies
INVESTIGATION FINDINGS:
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On 10-14-22 at 2:45pm, Licensing Program Analysts (LPAs) Michael Bilger and Renee Campbell arrived unannounced to continue investigation and deliver complaint findings for the allegations listed above. LPA met with Administrator Anuradha Saini and explained the purpose of the visit. During this investigation, LPA interviewed 7 staff, Administrator and 3 residents. LPA also reviewed facility file documentation including Actual hours worked for August 2022, staffing schedule for August of 2022, Physician’s reports for Resident1 (R1) and R2, functional capabilities assessment, med tech communication form, footcare wellness form, pest control service agreement, and additional documentation including training verification and menu. Additionally, LPA conducted facility observation of memory care and kitchen.

Allegation #1: Staff failed to provide adequate food service. This allegation stated facility did not provide adequate amounts of snacks to residents during night shift. LPA interviewed Staff1 (S1), S2, S3, S4, S5, S6, and S7 in addition to Administrator. LPA also conducted kitchen observation and observation of memory care on 8-26-22 and 10-14-22. LPA also interviewed Resident1 (R1), R2, and R3.. {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: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
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
Control Number 27-AS-20220818164143
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: 10/14/2022
NARRATIVE
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 LPA also reviewed facility’s menu. Based on interviews, record reviews, and observation, it was determined that facility has available snacks and other food items available for residents during night shift including a surplus of items as noted during observation on 8-26-22 including various sandwiches. Interviews conducted did not reveal a shortage of food item availability or inadequate delivery of food to residents during the night. As a result, there is not a preponderance of evidence to conclude staff failed to provide adequate food service, and this allegation is UNSUBSTANTIATED.

Allegation #2: Staff are not taking precautions for COVID-19. LPA conducted facility observation of memory care on 8-26-22 and 10-14-22, and reviewed additional documentation from facility. LPA observed isolation carts stocked with adequate amounts of personal protective equipment (PPE) outside of COVID designated rooms, and observed COVID room designated appropriately with use of color coding. Unit was observed to be clean and sanitary. Staff on duty was observed to be wearing appropriate PPE. Additionally, COVID signage was observed to be posted and resident’s with COVID were observed to be appropriately isolated. Training documentation revealed COVID-19 precautionary training conducted on multiple dates between June and August of 2022. Interviews conducted with S1-S7 as well as Administrator and R1-R3 revealed COVID precautions are followed or not observed to be inappropriately followed. Based on observations, interviews, and record reviews there is not a preponderance of evidence to conclude this allegation is true, therefore this allegation is UNSUBSTANTIATED.

Allegation #3: Due to lack of supervision residents engaged in inappropriate interactions. LPA conducted observation of memory care on 8-26-22 and 10-14-22, and reviewed additional facility documentation. LPA also interviewed S1-S7, Administrator and R1-R3. LPA observed residents interacting appropriately during meal and other activities.

{Cont. on 9099C}

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20220818164143
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: 10/14/2022
NARRATIVE
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Records reviewed could not clearly determine if any inappropriate interactions were conducted by residents in care. Based on interviews, record reviews, and observation, it was determined that since there have been no clear observations of inappropriate interactions between residents as a result of a lack of supervision through record review and observation, the preponderance of evidence standard is not met and this allegation is UNSUBSTANTIATED.

Allegation #4: Staff handle residents in a rough manner and yell at residents. LPA conducted facility observation on 8-26-22 and 10-14-22, and interviewed staff and residents as noted above, and reviewed additional documentation. Based on observation and interviews, it was determined that there has been no recollection of confirmed rough handling or yelling at residents in care. Additionally, based on record review, it was determined that rough handling or yelling at residents was not decisively revealed. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Allegation #5: Residents are left in soiled clothing. LPA interviewed staff and residents as noted above. LPA also reviewed additional documentation and conducted facility observation on 8-26-22 and 10-14-22. Based on interviews and record reviews, it was determined that residents in care have not reportedly been left in soiled clothing for inappropriate lengths of time. Observation of facility revealed no foul odors. Based on interviews, record reviews, and observation, the preponderance of evidence standard is not met and this allegation is UNSUBSTANTIATED.

Allegation #6: Facility is malodorous. LPA conducted facility observation on 8-26-22 and 10-14-22, and conducted interviews with staff and residents as noted above. Based on observation, it was determined that memory care unit did not contain foul odors. Furthermore, based on interviews, it was determined that there has been no recollection of a malodorous environment within memory care unit. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. {Cont. on 9099C}

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20220818164143
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: 10/14/2022
NARRATIVE
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Allegation #7: Facility has an infestation of insects. LPA conducted facility observation on 8-26-22 and 10-14-22, and conducted interviews with staff and residents as noted above, and reviewed additional documentation. Based on observation and interviews, it was determined that although cockroaches were reportedly observed on the outside of facility they were not observed within the inside of facility. Additionally, record review revealed one insect crawling on the floor which was undetermined to be that of facility’s. A pest control service agreement reviewed revealed an on-going pest control service in place for facility. As a result, there is not a preponderance of evidence to conclude that facility has had an infestation of insects, therefore this allegation is UNSUBSTANTIATED.

Allegation #8: Facility has an outbreak of scabies. LPA conducted interviews with staff and residents as noted above, and reviewed facility file documentation. Based on interviews and record reviews, it was determined that although a rash was existent on resident1 (R1) it was undetermined and unconfirmed through an appropriate skilled professional that said rash was scabies. Additionally, record review revealed treatment practices were in place for the diagnosed skin rash, and that no cases of scabies have been diagnosed at this time. Based on interviews and record reviews, there is not a preponderance of evidence to conclude that residents in care contained scabies, and this allegation is UNSUBSTANTIATED.

No citations are issued today as result of this investigation. An exit interview was conducted with Anuradha Saini and a copy of this report was left with Anuradha. Appeal rights provided.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4