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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:07:29 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
04/24/2023 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20230424134903
FACILITY NAME:A1 DEL MONTE STOCKTONFACILITY NUMBER:
392700993
ADMINISTRATOR:SAINI, ANURADHAFACILITY TYPE:
740
ADDRESS:517 E. FULTON STREETTELEPHONE:
(209) 910-5910
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:158CENSUS: 144DATE:
05/17/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Mark BaddasTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure resident is accorded privacy during phone calls
Staff does not ensure resident has a comfortable mattress
Staff do not ensure resident's dietary restrictions are followed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5-17-23 at 11:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss 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 conducted interviews with 4 residents and 7 staff members. LPA also conducted facility observations on 4-27-23 and 5-10-23. Additionally, LPA reviewed facility file documentation including physician’s report for resident1 (R1), individualized service plan for R1, facility menu, receipt of items purchased, care notes, and dietary notes.
Allegation #1: Staff do not ensure resident is accorded privacy during phone calls. LPA conducted facility observations and interviews as stated above. Based on observations, it was revealed that residents in care have phones installed which are utilized to make private calls and direct calls to care staff for assistance. It was further revealed through interviews that care staff are not able to intercept or manipulate phone calls and associated conversations based on the current system used.

{Cont. on LIC 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 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 4
Control Number 27-AS-20230424134903
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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5
6
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8
9
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12
13
14
15
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18
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27
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32
Additional interviews conducted did not reveal corroborated statements indicating staff are purposely listen in on or disrupting private calls. As result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.
Allegation #2: Staff does not ensure resident has a comfortable mattress. LPA conducted interviews and facility observations as stated above. LPA also reviewed a receipt of items purchased submitted by Administrator. Based on interviews and record reviews, it was revealed that resident1 (R1) was admitted to facility on 4-12-23, prior to admission, R1’s previous skilled nursing facility ordered a mattress which was delivered, yet not utilized due to R1’s request. Prior to admission, based on interviews, it was further revealed that facility staff attempted to process a physician’s order for a gel mattress which was on back order. Receipt of purchased items indicated facility purchased a 3-inch mattress topper to be place on R1’s current mattress to aid in R1’s comfort. LPA observed ordered mattress at facility awaiting pick up by delivery company. As result, it is revealed that facility made attempts to assist R1 with comfort in relation to mattress. The preponderance of evidence standard is not met to indicate facility did not ensure a comfortable mattress; therefore, this allegation is UNSUBSTANTIATED.
Allegation #3: Staff do not ensure resident’s dietary restrictions are followed. Allegation states R1 was given onions and garlic in meals served on 4-15-23 and 4-16-23 as well as oranges and bananas. LPA reviewed dietary notes, physician’s report, individualized service plan, and menu as stated above. LPA also conducted interviews as stated above. Based on records reviewed, it was revealed that onions, garlic, and squash were among the food items R1 was not to receive. It was further revealed that dietary had in possession dietary notes indicating restriction for R1. Based on interviews conducted it was revealed that dietary staff are aware of restrictions and utilize a procedure to ensure residents in care receive food items per requests and established restrictions which includes resident names labeled on trays to ensure accurate delivery of meals. A review of facility’s menu did not indicate food items containing onions or garlic were served on the dates specified above. Interviews conducted did not indicate corroborated statements of staff not following residents’ dietary restrictions or requests. As a result, there is not a preponderance of evidence to conclude facility staff is not making efforts to ensure R1’s or other resident dietary restrictions are followed. Therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Mark Baddas and a copy of this report was provided to Mark. Appeal rights provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 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 4
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
04/24/2023 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20230424134903

FACILITY NAME:A1 DEL MONTE STOCKTONFACILITY NUMBER:
392700993
ADMINISTRATOR:SAINI, ANURADHAFACILITY TYPE:
740
ADDRESS:517 E. FULTON STREETTELEPHONE:
(209) 910-5910
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:158CENSUS: DATE:
05/17/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:TIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
 Staff are not following the resident's admission agreement
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5-17-23 at 11:30am Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the allegation noted above. LPA met with interim Executive Director Mark Baddas and explained the purpose of the visit. During this investigation, LPA reviewed admission agreement for R1 and conducted interviews with staff1 (S1) and S2.
Allegation: Staff are not following the resident’s admission agreement. This allegation referred to a meal charge stated in admission agreement. LPA reviewed admissions agreement for R1 and conducted interviews as stated above. Based on records reviewed, it was revealed that facility states in admission agreement that a $10.00 charge per meal is assessed when delivered to residents’ rooms except in circumstances relating to various conditions of the residents. It was further revealed that said service is not included in the basic service requirements per regulation. Additionally, based on interviews, it was revealed that R1 is not and will not be charged for any meals delivered to R1’s room. As a result, there is not a preponderance of evidence to concluded facility is not following admission agreement, and this allegation is UNFOUNDED. {Cont. on LIC 9099C}

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 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: 3 of 4
Control Number 27-AS-20230424134903
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
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
An exit interview was conducted with Mark Baddas and a copy of this report was provided to Mark
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 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: 4 of 4