392700993-8-15-2023-27-AS-LKIG-CUZ79P-20230823212815

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 08/15/2023
Date Signed: 08/15/2023 11:47:18 AM

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
07/03/2023 and conducted by Evaluator Michael Bilger

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230703083122

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: 147	DATE:	08/15/2023
		UNANNOUNCED	TIME BEGAN:	10:28 AM
MET WITH:	Lucky Kaur		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Facility failed to prevent the spread of head lice

INVESTIGATION FINDINGS:

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On 8-15-23 at 10:28am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to deliver findings for the complaint allegation noted above. LPAs met with Director of Nursing Lucky Kaur and explained the purpose of the visit. During this investigation, LPA interviewed 8 staff members and 3 residents. LPA also conducted a facility observation on 7-12-23 and 8-4-23. Additionally, LPA reviewed facility file documentation including individualized service plan (ISP) and physician’s report for resident1 (R1). Based on interviews and record reviews, it was determined that R1 resided at facility until approximately end of May 2023 and discharged to another licensed facility and received services noted in the ISP. Interviews, record reviews and observations conducted further revealed during this investigation that there were no corroborated statements or evidence to prove head lice existed in facility during or after R1’s residency.
As a result, the preponderance of evidenced standard is not met, and this allegation is UNSUBSTANTIATED. An exit interview was conducted with Lucky Kaur and a copy of this report was provided to Lucky. Appeal rights provided.

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: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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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