392700993-5-16-2024-27-AS-LRIS-D5HQXU-20240522123408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 05/09/2024
Date Signed: 05/16/2024 10:03:28 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2024 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240209094219

FACILITY NAME:	A1 DEL MONTE STOCKTON		FACILITY NUMBER:	392700993
ADMINISTRATOR:	SANDEEP SAINI		FACILITY TYPE:	740
ADDRESS:	517 E. FULTON STREET		TELEPHONE:	(209) 910-5910
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY:	158	CENSUS: 156	DATE:	05/09/2024
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Lucky		TIME COMPLETED:	03:06 PM

ALLEGATION(S):

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Staff are not adequately trained
Unqualified staff dispenses medication
Staff are not following the monthly menu

INVESTIGATION FINDINGS:

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On 5/9/2024, LPA Johnson arrived unannounced to deliver findings. LPA met with Sunny.

Allegation: Staff are not adequately trained. Records reviewed and interviews conducted confirmed that the facility provided the required training for Personnel and Medtech. The facility is using the regulatory requirements as outlined in Title 22. (87411 Personnel Requirements) to maintain compliance. The department has investigated the allegation and was unable to confirm that staff are not adequately trained. The allegation is unsubstantiated.

Allegation: Unqualified staff dispenses medication. Records review confirm that the facility is using only trained staff to provide medication administration.

Continued

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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-20240209094219

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: A1 DEL MONTE STOCKTON	FACILITY NUMBER: 392700993
	VISIT DATE: 05/09/2024

NARRATIVE

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The information included in the complaint refers to PRN(the medication can be administered on an as needed basis) medications being given by unqualified staff. The records confirm that the facility is having trained Medtech pass PRN medication. The department was unable to confirm that other unqualified staff members passed PRN medications during times.

Regulation 87465 (d) reads: that If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met:(1)Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication.
(2)The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record.
(3)The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. The facility appears to be following this regulatory requirements, based on records reviewed.

Allegation: Staff are not following the monthly menu. Based on review of the records, interviews with the residents and staff the facility provides monthly menus. Staff confirmed that they eat meals at the facility and the menu is accurate on most occasions.(If not the residents have usually eaten all the main items from the monthly menu.) The residents interviewed stated that if an items run out the facility will have alternative items to choose from. The residents enjoy the variety of food offered and had no complaints about the food choices. All allegations are Unsubstantiated.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

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