392700993-8-21-2023-27-AS-KHOS-CV6LW5-20230829090635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 08/21/2023
Date Signed: 08/21/2023 12:55:21 PM

Unfounded

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
08/16/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230816112547

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: 150	DATE:	08/21/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Lucky Kaur		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility illegally evicted resident

INVESTIGATION FINDINGS:

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On 8-21-23 at 10:25am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to open and investigate the complaint allegation noted above. LPAs met with Assistant Executive Director Lucky Kaur and explained the purpose of the visit. During this investigation LPAs interviewed Administrator and resident1 (R1). LPAs also reviewed admission agreement for R1, Physician's report for R1, functional capablities assessment for R1, and discharge paperwork for R1. Based on interviews and record reviews, it was determined that R1 was transported to local emergency department on 8-14-23 after R1 had a discussion with facility staff and signed a notice to discharge. It was further determined that facility accepted resident back to residency on 8-18-23 at approximately 5:30pm and R1 is now currently residing in R1's room.

As a result, the preponderance of evidence standard is not met, and this allegation is UNFOUNDED. An exit interview was conducted with Lucky Kaur and a copy of this report was provided to Lucky.

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: 08/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

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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