392700993-8-28-2024-27-AS-LRIS-D9GQ7E-20240926115501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 08/28/2024
Date Signed: 08/28/2024 04:13:27 PM

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
06/17/2024 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240617091338

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:	08/28/2024
		UNANNOUNCED	TIME BEGAN:	01:58 PM
MET WITH:	S. Sandeep		TIME COMPLETED:	04:29 PM

ALLEGATION(S):

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Staff handled resident in a rough manner
Staff did not administer residents medication in a timely manner
Staff are not meeting residents diapering needs
Staff are not meeting residents laundry needs
Staff did not ensure the facility was free of mold

INVESTIGATION FINDINGS:

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Allegation: Staff handled resident in a rough manner. During the investigation residents and staff were interviewed all interviewed denied witness or being handled in a rough manner. Residents stated that some of their housemates can be aggressive toward the staff when it comes time for medications and some residents are verbally aggressive and impatient with the Medtechs. The department has witnessed medication passes and confirmed that some residents are verbally agressive and impatient during the medication administration time. The allegation is unsubstantiated.

Allegation: Staff did not administer residents medication in a timely manner. The department reviewed the medication administration record, witnessed medication passes and interviewed residents. The departemnt was not able to confirm that medication was not being given timely. During the monitoring of medication administration the facility was within the times of giving medication. The allegation is unsubstantiated.

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: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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-20240617091338

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: 08/28/2024

NARRATIVE

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Allegation: Staff are not meeting residents diapering needs. ADL schedules were compared to the service plans and all residents who require the assistance with changing briefs are being assisted according to the times listed. Some residents are scheduled for every two hours or as needed and some more often. Based on records reviewed and observation the residents in memory care and assisted living side are being changed to meet their incontinence needs. The department was unable to establish a time that the residents on either side were not changed the records support the service plans reviewed by the department. The allegation is unsubstantiated.

Allegation: Staff are not meeting residents laundry needs. The investigation into this matter included an inspection of the laundry area and residents rooms including the clothes hampers. Based on inspection and observation the facility is providing assistance with laundry the facility has scheduled times for residents to expect their laundry to be completed. The laundry area is well maintained and has the expected bundles of clothing that is either clean and being folded or dirty and waiting to be cleaned. The residents' clothes are marked with their initials. The allegation is unsubstantiated.

Allegation: Staff did not ensure the facility was free of mold. Based on records reviewed and inspections of the facility the department was unable to identify an area that had mold the facility has a shower located on the second floor that was holding moisture after a resident showered. The resident was taking a shower for one hour and had to be redirected about showering. The moisture made the bathroom humid but did not create mold. The facility addressed the moisture problem with ventilation and cleaning. No mold was observed by the department on inspection. The allegation is unsubstantiated.

As a result of this investigation, this Department finds the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted with Administrator

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

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