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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700993
Report Date: 11/04/2022
Date Signed: 11/04/2022 04:48:19 PM


Document Has Been Signed on 11/04/2022 04:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 STOCKTONFACILITY NUMBER:
392700993
ADMINISTRATOR:SAINI, ANURADHAFACILITY TYPE:
740
ADDRESS:517 E. FULTON STREETTELEPHONE:
(209) 910-5910
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:158CENSUS: 100DATE:
11/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Anuradha SainiTIME COMPLETED:
03:00 PM
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On 11-4-22 at 1:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding staffing and lift assists. LPA met with Administrator Anuradha Saini and explained the purpose of the visit. LPA interviewed Administrator and reviewed staffing schedule for 10-29-22 night shift. LPA also reviewed incident report for resident1 (R1). Based on interviews and record reviews, it was determined that R1 sustained an unwitnessed fall without injury on 10-29-22, and staff notified fire department for a lift assist. It was further determined that R1 refused to go to the hospital. Staffing on 10-29-22 night shift included 1 med tech and 3 caregivers. LPA offered technical assistance on when facility shall call 9-1-1 and additional resources utilized for assistance with lifts including but not limited to: Use of mechanical lifts or other means provided appropriate documented training is in place. Administrator stated additional training will be put in place for staff to recognize need for 9-1-1 calls versus needed internal assistance for residents in care.

No deficiencies cited today as a result of this case management. An exit interview was conducted with Anuradha Saini and a copy of this report was left with Anuradha.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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