392700993-3-24-2023-27-AS-KHOS-CQZP8P-20230418110550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 03/24/2023
Date Signed: 03/24/2023 05:01:22 PM

Substantiated

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
03/03/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230303140934

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: 137	DATE:	03/24/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Anuradha Saini		TIME COMPLETED:	02:56 PM

ALLEGATION(S):

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Staff are not keeping facility free of odor
Staff did not maintain the facility in clean and sanitary condition

INVESTIGATION FINDINGS:

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On 3-24-23 at 12:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation for the allegations noted above. LPA met with Administrator Anuradha Saini and explained the purpose of the visit. During this investigation, LPA conducted facility observation on 3-9-23 and 3-24-23. LPA also conducted interviews with Administrator, Staff1 (S1), S2 and S3.

Allegation #1: Staff are not keeping facility free of odor. Based on observations conducted, LPA observed a foul odor around room 107 on 3-24-23. It was further determined that odor was strongest and more easily detected upon LPA entering room 107. As a result, there is a preponderance of evidence to conclude facility was not maintaining an area free of odor, therefore, this allegation is SUBSTANTIATED.

Allegation #2: Staff did not maintain the facility in clean and sanitary condition. Based on observations conducted, LPA observed room 107 to contain a used adult diaper on the floor near the foot of the bed belonging to R1. It was further determined that this item contributed in part to foul odors within the room.
{Cont. on 9099C}

Substantiated

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: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

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-20230303140934

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: 03/24/2023

NARRATIVE

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As a result, there is a preponderance of evidence to conclude facility did not maintain a clean and sanitary condition, therefore this allegation is SUBSTANTIATED.

As a result of this investigation, citations are issued under Title 22, Division 6. A civil penalty in the amount of $250 was issued in addition to citation due to repeat violation within 12 month period. An exit interview was conducted with Anurahda Saini and a copy of this report was provided to Anuradha. 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: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20230303140934

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: 03/24/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/04/2023 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	87625(b)(3). Managed Incontinence. (b) ...the licensee shall be responsible for the following: (3) Ensuring that...facility remains free of odors from incontinence. This requirement was not as evidenced by:	1 2 3 4 5 6 7	Licensee will submit a plan to ensure incontinent residents are kept clean and dry, and rooms, along with surrounding areas are kept odor free. Plan to be submitted to LPA by POC due date.
	8 9 10 11 12 13 14	Based on observation, licensee did not comply with this regulation in that LPA observed a strong urine odor in and around room 107 on 3-24-23. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
Type B 04/04/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will submit a plan to ensure rooms, common areas, and other areas used by residents remain clean and sanitary. Plan to be submitted to LPA by POC due date.
	8 9 10 11 12 13 14	Based on observation, licensee did not comply with this regulation in that LPA observed a used adult diaper on the floor of room 107 near the foot of R1's bed. This posed a potential health and safety risk to residents in care.	8 9 10 11 12 13 14

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 King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC9099 (FAS) - (06/04)

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