392700993-11-3-2023-27-AS-LKIG-CY2LYN-20231129081036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 11/03/2023
Date Signed: 11/03/2023 03:29:26 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
09/08/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230908081138

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:	11/03/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Lucky Kaur		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility staff are not cleaning residents’ room(s).
Facility staff stole residents’ personal property.
Facility staff are not ensuring that residents have toilet paper in their rooms.
Staff are denying food to residents.

INVESTIGATION FINDINGS:

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On 11-3-23 at 2:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegations noted above. LPA met with Assistant Executive Director (AED) Lucky Kaur and explained the purpose of the visit. Administrator Anuradha Saini was made aware of LPAs visit and purpose. During this investigation, LPA conducted interviews with 6 staff members and 4 residents in care. Additionally, LPA reviewed facility file documentation including housekeeping task schedule, behavior progress notes, physician reports , facility menu, inventory sheets, and admission agreements. LPA also conducted a facility observation on 9-12-23 and 10-17-23.

Allegation: Facility staff are not cleaning residents’ rooms. LPA conducted interviews, record reviews, and facility observations as stated above. LPA also conducted facility observations as noted above. Based on interviews, it was revealed that housekeeping staff are observed to be regularly attending to residents’ rooms as scheduled and perform duties as required with the exception of residents who may decline services for various reasons.

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: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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 3

Control Number 27-AS-20230908081138

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: 11/03/2023

NARRATIVE

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LPA’s review of housekeeping tasks schedule revealed rooms are scheduled to be clean on specific days which includes deep cleaning in various rooms as necessary. LPA’s observation revealed a presence of adequate housekeeping staff performing cleaning duties. LPA also observed various resident rooms to be adequately cleaned with no foul odors or stains on walls and floors within resident rooms and throughout facility. As a result, there is not a preponderance of evidence to conclude facility staff are not cleaning residents’ rooms. Therefore, this allegation is UNSUBSTANTIATED.

Allegation: Facility staff stole residents’ personal property. LPA conducted interviews and record reviews as stated above. Based on interviews, it was revealed that residents are presented with the option to inventory items upon admission and thereafter. Additionally, interviews did not reveal any corroborated statements of facility staff stealing residents’ personal property. Interviews conducted with residents further revealed all items were accounted for within resident rooms. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Allegation: Facility staff are not ensuring that residents have toilet paper in their rooms. LPA conducted interviews, record reviews, and facility observations as stated above. Based on interviews, it was revealed that toilet paper and other related necessary personal supplies are provided to residents regularly and per request. LPA facility observations further revealed toilet paper on holders and additional supply of toilet paper on countertops in various resident bathrooms. LPA’s observation of housekeeping supplies closet revealed an adequate amount of toilet paper on hand. As a result, there is not a preponderance of evidence to conclude facility staff are not ensuring residents have toilet paper in their rooms, therefore, this allegation is UNSUBSTANTIATED.

Allegation: Staff are denying food to residents. LPA conducted interviews, record review, and facility observations as stated above. Based on interviews conducted, there were no corroborated statements of facility staff denying food to residents. Observations by LPA revealed adequate amounts of food supply in kitchen for the resident current census. Observations also revealed residents receiving food items which matched the menu items for the given days. Interviews conducted revealed that the facility makes available and provides additional food items to residents upon request prior to and after scheduled mealtimes. Furthermore, interviews did not reveal corroborated statements of residents being denied food for any reason.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230908081138

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: 11/03/2023

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	As a result, there is not a preponderance of evidence to conclude staff are denying food to residents, therefore, 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.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC9099 (FAS) - (06/04)

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