392700993-5-17-2023-27-AS-LKIG-CS4M2K-20230523091338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 05/17/2023
Date Signed: 05/17/2023 02:29:13 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
04/19/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230419101259

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: 145	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Mark Baddas		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff does not ensure resident is administered medications in a timely manner.
Staff is providing unprescribed medications to resident.
Staff does not attend to resident when requested.
Staff does not ensure resident's showering needs are met.
Staff does not ensure resident's room and bathroom is cleaned.
Staff does not answer facility phone.

INVESTIGATION FINDINGS:

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On 5-17-23 at 10:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss complaint findings for the allegations noted above. LPA met with interim executive director Mark Baddas and explained the purpose of the visit. During this investigation, LPA interviewed 4 residents and 5 staff. LPA also conducted facility observations on 4-27-23 and 5-10-23. Additionally, LPA reviewed facility file documentation including shower schedule, care notes, individualized service plan, housekeeping schedule, physician’s report, medication lists and orders, housekeeping sign off sheets, and medication logs.
Allegation #1: Staff does not ensure resident is administered medications in a timely manner. LPA conducted interviews as stated above and reviewed medication orders and log sheets for resident1 (R1). LPA compared medication orders on file with medication log sheets. LPA also reviewed physician’s report for R1. Facility records medication given to residents in care via electronic format.

{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: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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 3

Control Number 27-AS-20230419101259

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: 05/17/2023

NARRATIVE

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Based on record reviews and interviews, it was revealed that facility staff assisted R1 with medications within the appropriate time frames per current physician orders and orders received upon R1’s admission on 4-12-23. As a result, there is a not a preponderance of evidence to conclude medications are not administered in a timely manner, therefore, this allegation is UNSUBSTANTIATED.
Allegation #2: Staff is providing unprescribed medications to resident. LPA conducted interviews as stated above and reviewed medication orders and log sheets for resident1 (R1). LPA compared medication orders on file with medication log sheets. LPA also reviewed physician’s report for R1. Facility records medication given to residents in care via electronic format. Based on interviews and record reviews, it was revealed that medication orders for R1 matched the medication log sheets used to determine what medications are given and when. Medications which were discontinued were indicated on the medication log sheets and discontinued accordingly per physician’s orders. As a result, there is a not a preponderance of evidence to conclude resident was provided unprescribed medications, therefore, this allegation is UNSUBSTANTIATED.
Allegation #3: Staff does not attend to resident when requested. LPA conducted interviews and care notes as stated above. LPA also conducted facility observations as stated above. Based on interviews, care notes and observations, it was revealed that resident needs were attended to within an appropriate time frame necessary meet specific needs of residents in care. Interviews conducted did not reveal any corroborated statements to indicate resident needs are not attended to when requested. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.
Allegation #4: Staff does not ensure resident’s showering needs are met. LPA reviewed shower schedule associated care notes, and individualized service plan as stated above. LPA also conducted interviews as stated above. Based on interviews and record reviews, it was revealed that showers were given per schedule with exception of one date which indicated R1 exercising right to refuse shower assistance. Shower schedule revealed showers for R1 are to be completed at least 2 times per week. Interviews conducted did not reveal corroborated statements of showers not received as scheduled. As a result, there is not a preponderance of evidence to conclude residents’ showering needs are not met, therefore this allegation is UNSUBSTANTIATED.

{Cont. on 9099C}

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20230419101259

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: 05/17/2023

NARRATIVE

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Allegation #5: Staff does not ensure resident’s room and bathroom is cleaned. LPA conducted facility observations and reviewed housekeeping schedule and associated sign off sheets as stated above. Additionally, LPA conducted interviews as stated above. Based on observations conducted, it was revealed that residents’ rooms and bathrooms were clean and sanitary and did not contain foul odors to further indicate uncleanliness. Housekeeping schedule revealed established dates and days of the week for cleaning of various rooms in specific sections of facility. Completion of tasks were revealed based on review of housekeeping sign off sheets. Interviews conducted did not reveal corroborated statements of rooms and bathrooms not cleaned appropriately and per housekeeping schedule. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Allegation #6: Staff does not answer facility phone. LPA conducted facility observations as stated above. LPA also conducted interviews as stated above. Based on observations, it was revealed that facility phones located in various resident rooms were answered within 2-3 rings and under one minute by care staff on duty. It was further revealed that phone call signified location of room calling for assistance. Interviews conducted did not reveal corroborated statements of staff not answering facility phone when calling for assistance. As a result, there is not a preponderance of evidence to conclude staff does not answer facility phone, therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Mark Baddass and a copy of this report was provided to Mark. 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: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

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