392700993-4-7-2023-27-AS-KHOS-CQZPN5-20230418112721

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 04/07/2023
Date Signed: 04/07/2023 03:33:55 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
03/20/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230320082353

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:	01:32 PM
MET WITH:	Anuradha Saini		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff allowed resident to remain in soiled clothing for extended period
Staff does not ensure resident has adequate storage space for personal possessions

INVESTIGATION FINDINGS:

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On 4-7-23, 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 conducted facility observation on 3-24-23 and 4-7-23. Additionally, LPA reviewed care logs and physician report for resident1 (R1).
Allegation #1: Staff allowed resident to remain in soiled clothing for extended period. LPA conducted interviews as noted above as well as facility observation, and records review as noted above. During facility tours on 3-24-23 and 4-7-23, LPA observed facility staff interacting with residents in care and meeting toileting, bathing, and other care needs. Record reviewed revealed care needs including resident changing of soiled clothing, showers, and hygiene performed within adequate time. Interviews conducted with residents and staff did not reveal consistent corroborated statements of residents remaining in soiled clothing for extended periods of time. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. {Cont. 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)

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Control Number 27-AS-20230320082353

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

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Allegation #2: Staff does not ensure resident has adequate storage space for personal possessions. LPA conducted facility tour and conducted interviews as noted above. During facility tour, LPA observed storage space adequate for residents in care and meeting regulatory compliance. Additionally, LPA observed items belonging to residents in care to be appropriately stored in storage spaces. Interviews conducted did not result in corroborated statements of facility not ensuring adequate storage space for resident’s personnel possessions. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Based on 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)

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