392700993-5-10-2023-27-AS-LKIG-CS4M48-20230523091619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 05/10/2023
Date Signed: 05/10/2023 04:29:21 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
04/18/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230418084718

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: 144	DATE:	05/10/2023
		UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Lucky Kaur		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff does not ensure resident's showering needs are met.
Staff does not ensure resident's needs are being met.

INVESTIGATION FINDINGS:

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On 5-10-23 at 10:22am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation and deliver findings related to the allegations noted above. LPA met with Director of Nursing Lucky Kaur and explained the purpose of the visit. During this investigation, LPA interviewed resident1 (R1) R2, R3, and R4. LPA also interviewed staff1 (S1), S2, S3, and S4. Additionally, LPA reviewed shower schedule for R1, physician’s report for R1, and conducted a facility observations.
Allegation #1: Staff does not ensure resident showering needs are met. LPA conducted interviews and reviewed records as stated above. LPA also conducted a facility observations on 4-19-23 and 5-10-23. Based on observation, interviews, and record review, it was determined that R1 received showers per shower schedule with an exception of one day in which R1 exercised her right to refuse a shower. Additionally, interviews revealed showers are given on a consistent bases per shower schedule. As a result, based on interviews, record reviews, and observation of R1’s living environment, there is a not a preponderance of evidence to conclude facility is not meeting residents showering needs. 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: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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-20230418084718

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: 05/10/2023

NARRATIVE

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Allegation #2: Staff does not ensure resident needs are met. This allegation states R1 has difficulty sleeping due to noise and requests to be moved to a skilled nursing facility. LPA conducted interviews and reviewed records as stated above. LPA also conducted a facility observation. Based on observation, interviews, and record review, it was determined that facility is meeting R1’s showering needs as stated above in Allegation #1. Additionally, based on interviews and facility observation, it was revealed that excessive noise was not observed or correlated with lack of residents sleep. As a result, there is not a preponderance of evidence to conclude that facility is not ensuring resident needs are met. Therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Anuradha 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: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC9099 (FAS) - (06/04)

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