392700993-12-6-2022-27-AS-KHOS-CM62Z8-20221215164954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 12/06/2022
Date Signed: 12/06/2022 03:53:36 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
10/26/2022 and conducted by Evaluator Michael Bilger

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221026104559

FACILITY NAME:	A1 DEL MONTE STOCKTON		FACILITY NUMBER:	392700993
ADMINISTRATOR:	SAINI, ANURADHA		FACILITY TYPE:	740
ADDRESS:	517 E. FULTON STREET		TELEPHONE:	(209) 910-5910
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY:	158	CENSUS: 114	DATE:	12/06/2022
		UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Lucky Kaur		TIME COMPLETED:	04:01 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff member stole checks from resident and forged them to himself.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 12-6-22 at 1:17pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation and deliver findings for the complaint allegation noted above. LPA met with Director of Nursing (DON) Lucky Kaur and explained the purpose of the visit. Administrator Anuradha Saini was made aware of LPA’s visit and gave permission for Lucky to sign in her absence. During this investigation, LPA interviewed Administrator, Staff1 (S1), Resident1 (R1) R2, and attempted interview with S2. LPA also reviewed physician’s report for R1, copies of various checks written, and staffing record for S2.
Based on interviews and record reviews, it was determined that various checks with various amounts were written on 6/14/22, 8/26/22, 9/2/22, and 9/10/22, made out to S2 which contained a signature and printed name of R1 on the checks, and cashed. It was further determined that R1 did not write such checks and discovered suspicious bank activity on 10/3/22 during a visit to R1’s bank which was after R1's discharge from facility on 9/29/22.. A review of S2’s staffing record revealed S2 was terminated from employment on 4-1-22.

{Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

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 2

Control Number 27-AS-20221026104559

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: 12/06/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Interviews further revealed that it was unclear how S2 would have had access to R1’s checks prior to or after S2’s termination. Additionally, based on interviews and record reviews, there were no reports recorded of R1 missing checks while a resident at facility. Incident described as above was reported accordingly and appropriately by facility upon discovery on 10-3-22.

Based on interviews and record reviews, although the incident may have occurred, there is not a preponderance of evidence to conclude that S2 was a facility staff member at the time R1’s checks were allegedly taken and written. As a result, this allegation is UNSUBSTANTIATED. DON left facility prior to completing this note, and gave permission for assistant administrator Alicia Carranza to sign in her absence. An exit interview was conducted with Alicia Carranza and a copy of this report was left with Alicia. Appeal rights provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2