392700993-5-17-2023-27-AS-KHOS-CSCL2K-20230531082229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:17:35 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
04/27/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230427082454

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:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Mark Baddas		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings
Staff did not provide resident with an extension cord
Staff are cutting off resident's phone calls
Staff are not able to communicate and understand resident's needs
Staff are not meeting resident's needs

INVESTIGATION FINDINGS:

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On 5-17-23 at 12:15pm, 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 interviewed 4 residents and 8 staff members. LPA also reviewed facility file documentation including dietary notes for Resident1 (R1), care notes for R1, facility menu, inventory sheet for R1, medication logs and orders for R1, individualized service plan for R1, and shower scheduled and notes for R1. Additionally, LPA conducted facility observations on 4-27-23, 5-10-23, and 5-17-23 as part of this investigation.
Allegation: Staff did not safeguard resident’s personal belongings. LPA reviewed inventory sheet and conducted interviews as stated above. Based on record review and interviews, it was determined that R1 placed music CDs on the inventory list upon admission on 4-12-23. It was further determined that a set of writing pens were not noted on the inventory sheet, however, observed by LPA during an observation visit to R1’s room conducted on 4-27-23. {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: 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-20230427082454

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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Inventory sheet further indicates music CDs were safeguarded and returned to R1 after a hospital stay on 4-14-23. Observation and interviews did not reveal decisively whether music CDs contained scratches or other form of damage to indicate ill safekeeping occurred. Interviews conducted did not reveal staff mishandled items of R1. Additional interviews did not reveal corroborated statements of staff members not practicing the safeguarding of residents’ personal belongings. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.
Allegation: Staff did not provide resident with an extension cord. LPA conducted facility observations and interviews as stated above. Based on interviews conducted, it was determined that an extension cord was present in the room in addition to other wall sockets for resident use. Additionally based on interviews it was revealed that facility staff was asked by R1 for an additional extension cord and informed R1 of other options available including a multi-plug outlet. An observation of R1s room determined 5 outlets are available for use. Based on interviews and observations, there is not a preponderance of evidence to conclude an extension cord, or alternatives were not offered and available for R1. Therefore, this allegation is UNSUBSTANTIATED.
Allegation: Staff are cutting off resident phone calls. LPA conducted interviews and facility observations as stated above. During facility observation, LPA attempted to utilize phone service in R1’s room and additional resident rooms. Observations revealed staff answered phone within 2-3 rings and under one minute without interrupting conversation. Interviews conducted did not reveal corroborated statements revealing staff interrupting or terminating resident private phone calls and conversations. As a result, there is not a preponderance of evidence to conclude staff are cutting off resident phone calls, therefore, this allegation is UNSUBSTANTIATED.
Allegation: Staff are not able to communicate and understand resident’s needs. LPA conducted interviews as stated above and reviewed facility file documentation as stated above. Allegation refers to communication regarding dietary needs for R1. LPA interviewed dietary staff including on-duty cooks. Interviews revealed staff were able to effectively verbalize and follow instructions regarding dietary needs and instructions for residents in care. Additionally, staff interviewed were able to answer interview questions appropriately. Additional interviews conducted did not reveal corroborated statements of staff unable to communicate and understand resident needs. As a result, the preponderance of evidence standard is not met, and 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 4

Control Number 27-AS-20230427082454

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: Staff are not meeting resident’s needs. LPA conducted interviews and facility observations as stated above. LPA also reviewed physician’s report for R1, individualized service plan for R1, and medication log sheets and physician’s orders for R1, and care notes for R1. Allegation refers to medication orders not followed as referenced in a previous complaint #27-AS-20230419101259. Based on records reviewed, it was revealed that facility attempted to address medication concerns with R1 on 4-13-23, 4-20-23, and 4-23-23, including a physician’s visit to facility on 4-21-23 to clarify and finalize orders. Additionally, care notes reviewed revealed staff was in communication with pharmacy for R1’s medication needs since admission date of 4-12-23 to clarify and receive any new medication. Based on care notes, a hospital visit was arranged on 4-14-23 to ensure resident receive appropriate medication regimen. It was further revealed through interviews and record reviews that facility was following medication orders as written and received during R1’s admission. Additional interviews conducted did not reveal corroborated statements of facility staff unable to meet medication and other resident needs at this time. As a result, there is not a preponderance of evidence to conclude facility staff did not meet the needs of R1 or other residents in care, therefore this allegation is UNSUBSTANTIATED.

An exit interivew was conducted with Mark Baddas and a copy of the 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)

Page: 3 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
04/27/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230427082454

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:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Mark Baddas		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Residents bathroom sink is not wheelchair accessible

INVESTIGATION FINDINGS:

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On 5-17-23 at 12:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss the 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 conducted facility observations on 4-27-23 and 5-10-23. LPA also interviewed 4 residents and 7 staff members.
Allegation: Residents bathroom sink is not wheelchair accessible. LPA conducted facility observations and interviews as stated above. Interviews did not reveal sink was not wheelchair accessible for resident needs. Observations conducted revealed sink in R1’s room was of adequate height. This height was consistent in other rooms observed by LPA. Additionally, LPA observed residents in care utilizing sink adequately for grooming and hygiene needs while in wheelchairs. As a result, the preponderance of evidence standard is not met and this allegation is UNFOUNDED.

An exit interview was conducted with Mark Baddas and a copy of this report was provided to Mark.

Unfounded

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: 4 of 4