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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700997
Report Date: 02/01/2024
Date Signed: 02/01/2024 01:54:03 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
01/31/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240131083407
FACILITY NAME:CAMLU ASSISTED LIVINGFACILITY NUMBER:
392700997
ADMINISTRATOR:CHANTLLE HUDSONFACILITY TYPE:
740
ADDRESS:6037 N. PERSHING AVENUETELEPHONE:
(209) 951-2030
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:160CENSUS: DATE:
02/01/2024
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:G. MonaresTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Licensee evicted resident without sufficient cause.
INVESTIGATION FINDINGS:
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On 2/1/24 at approximately 10:00am Licensing Program Analyst (LPA) Albert Johnson arrived at facility unannounced to investigate the above listed allegation. LPA Johnson met with Gretchen Monares and explained the purpose of today's visit.

Based on records reviewed LPA was able to determine that on or about 3/23/23, R1 was in a verbal and physical altercation with R2; two staff witnessed R1 pull the walker of R2 and then kicked R2. The documentation does not say where R2 was kicked. Police were not called, no SOC 341 submitted or an incident report to the department.

Continued
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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 2
Control Number 27-AS-20240131083407
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: CAMLU ASSISTED LIVING
FACILITY NUMBER: 392700997
VISIT DATE: 02/01/2024
NARRATIVE
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R1 denied that the incidents occurred as reported, but, confirms that the incident described in this report happened.

The department has determined that the facility did not report this incident that is being identified as the reason along with other alleged incidents to deliver 30 day notices to R1.

The facility was given a citation on 12/4/23 for not reporting the incident. Therefore, no citations will be given for not reporting this incident.

The facility did submit the 30 day notice to the department and the notice was a legal notice that contain the required information including resources for alternative housing and assistance.

Based on records reviewed and the review of the resident's 30 day notice, the preponderance of evidence standards has not been met. The allegation is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, the preponderance of evidence standards has not been met.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies are being cited. Exit interview held, a copy of report given.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2