392700993-4-7-2023-27-AS-KHOS-CQZP8N-20230418110550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 04/07/2023
Date Signed: 04/07/2023 03:31:10 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
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: 141	DATE:	04/07/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Anuradha Saini		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not ensuring resident is bathed
Staff did not ensure toilet paper was available for residents
Staff are not providing adequate food service to residents

INVESTIGATION FINDINGS:

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

On 4-7-23 at 10:00am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue a complaint investigation for the allegations noted above. LPA met with Administrator Anuradha Saini and explained the purpose of the visit. During this investigation, LPA interviewed 6 staff members, Administrator, and 4 residents. LPA also reviewed current facility menu and conducted a facility observation. Additionally, LPA reviewed shower schedule for resident1 (R1).
Allegation #1: Staff are not ensuring residents are bathed. LPA interviewed Resident1 (R1), R2, R3 and R4 as well as Staff1 (S1), S2, S3, S4, S5, and S6. LPA also reviewed shower schedule as noted above. Based on interviews and record reviews, it was determined that showers are attempted and completed consistently. It was further noted based on interviews and record reviews that residents also refuse showers periodically. A facility observation conducted on on 3-24-23, and 4-7-23 revealed no foul odors in facility, and LPA observed staff members interacting with residents for care needs including showers. As a result, there is not a preponderance of evidence to conclude that residents are not being bathed. Therefore, this allegation is UNSUBSTANTIATED. {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: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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 2

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: 04/07/2023

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

Allegation #2: Staff did not ensure toilet paper was available to residents. LPA conducted facility observation on 4-7-23 and 3-24-23, and 3-9-23, and interviewed residents as noted above. Based on observation and interview, it was determined that facility has an adequate supply of toilet paper on hand. Additionally, LPA observed toilet paper in various rooms during facility tours to contain toilet paper available on holders as well as additional toilet paper stored in bathrooms. Interviews conducted revealed supplies including toilet paper are available consistently. As a result, there is not a preponderance of evidence to conclude that toilet paper is not available to residents. Therefore, this allegation is UNSUBSTANTIATED.

Allegation #3: Staff are not providing adequate food service to residents. LPA conducted facility observation on 4-7-23, 3-24-23, 3-9-23 and interviewed staff and residents as noted above. LPA also reviewed facility’s menu. Based on record review, interviews, and observation, it was determined that facility is serving food consistent with published menu. Additionally, interviews conducted did not reveal corroborated statements of inadequate food service. As a result, there is not a preponderance of evidence to conclude that staff are not providing adequate food service to residents, therefore, this allegation is UNSUBSTANTIATED.

As a result of this investigation, no citations are issued. 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 King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2