392700993-7-20-2021-27-AS-LKIG-C582SH-20210723173909

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 07/20/2021
Date Signed: 07/20/2021 10:31:23 AM

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
07/02/2021 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20210702100911

FACILITY NAME:	A1 DEL MONTE STOCKTON		FACILITY NUMBER:	392700993
ADMINISTRATOR:	LASLEY, KARON		FACILITY TYPE:	740
ADDRESS:	517 E. FULTON STREET		TELEPHONE:	(925) 222-0430
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY:	158	CENSUS: 50	DATE:	07/20/2021
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Anuradha Saini		TIME COMPLETED:	10:27 AM

ALLEGATION(S):

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Care and Supervision
Resident Incontinent Care Needs Not Met
Residents not provided quantity or quality nutritious meals
Resident incidents not reported
Residents not provided safe accommodations

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Bilger arrived unannounced at facility on 7-20-21 at 9:05am to deliver findings for the above allegations. LPA was greeted by staff member upon arrival and met with Administrator Anuradha Saini who arrived at 9:50am. LPA explained the purpose of the visit. During the course of the investigation, LPA conducted interviews with staff and residents. LPA also reviewed facility records including, but not limited to resident roster, staffing roster, menu, incident reports, staffing schedule, and actual hours worked. LPA also conducted observation of resident care and facility overall.

Allegation #1: Lack of Care and Supervision and Allegation #2 Resident incontinent care needs not met: LPA conducted interviews with staff on 7-7-21, 7-10-21, and 7-16-21 and residents on 7-7-21. LPA also reviewed staffing schedule and actual hours for caregivers working on night shift. This included actual start times at night on 6-30-21 and into early morning hours on 7-1-21. LPA also conducted observation of care on 7-10-21 at 6:23am.
(Cont. on LIC 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: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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-20210702100911

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: 07/20/2021

NARRATIVE

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Based on interviews conducted, record reviews, and observation it was revealed that licensee was able to meet the care and supervision needs of residents utilizing the staffing resources available on 6-30-21, 7-1-21 and 7-10-21. As a result, the preponderance of evidence standard is not met, therefore, this allegation is UNSUBSTANTIATED.

Allegation #3: Residents not provided quantity or quality nutritious meals: LPA conducted interviews with residents on 7-7-21 and conducted observation of lunch meal on 7-7-21. LPA also reviewed facility’s current menu. Based on interviews with residents and staff it was revealed that residents were satisfied with the quantity and quality of food served. Based on LPA’s observation and review of menu, it was revealed that food portions were of adequate size and quality presentation. Review of menu also revealed that scheduled snacks and desserts were available. Based on observations, interviews, and record reviews it is determined that the preponderance of evidence standard is not met, therefore this allegation is UNSUBSTANTIATED.

Allegation #4: Resident incidents not reported: LPA conducted staff interviews and record reviews on 7-7-21. Record reviews and interviews revealed an incident occurring on 6-30-21 which was reported to the Department within appropriate time frame. Additional record reviews of past incidents revealed reporting requirements were met. Incident from 6-30-21 was reported during LPA’s visit on 7-7-21. Based on record reviews and interviews, it is determined that the preponderance of evidence standard is not met, therefore, this allegation is UNSUBSTANTIATED.

Allegation #5; Residents not provided safe accommodations: LPA conducted staff interviews and facility observation on 7-7-21. LPA toured facility inside and out including memory care unit. LPA did not observe any dangerous objects accessible to residents or other unsafe accommodations. Based on interviews, it was revealed that contractors are not scheduled to conduct work in the memory care unit. Staff interviews also revealed no witness of contractor work in memory care unit on the night of 6-30-21 or during the early morning hours of 7-1-21. Doors in memory care were functioning appropriately and provided adequate security based on LPA observations on 7-7-21 and 7-10-21. Based on observation and interviews, it is determined that the preponderance of evidence standard is not met, therefore, this allegation is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged incident occurred.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

LIC9099 (FAS) - (06/04)

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