<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701278
Report Date: 02/06/2024
Date Signed: 02/06/2024 03:46:33 PM

Unfounded


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
01/18/2024 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20240118123724
FACILITY NAME:CHEROKEE RETIREMENT HOMEFACILITY NUMBER:
392701278
ADMINISTRATOR:SINGH, JAGTARFACILITY TYPE:
740
ADDRESS:4124 CHEROKEE RDTELEPHONE:
(209) 518-1908
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY:15CENSUS: 12DATE:
02/06/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jagtar SinghTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff have not addressed the leaks on the facility grounds
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 2-6-23 at 12:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation for the allegation noted above. LPA met with Administrator Jagtar Singh and explained the purpose of the visit. Administrator had to depart and authorized lead caregiver (S1) to sign in his absence. During this investigation, LPA conducted facility observations on 1-25-24 and 2-6-24. LPA also conducted interviews with two staff members and three residents in care. Additionally, LPA reviewed documentation pertaining to facility repairs. Based on interviews, record reviews, and observations, it was determined that facility did not demonstrate leaks in the roof or evidence of roof leakage at this time. Observations revealed a heavy tarp placed on the roof to mitigate any potential occurrance of leaks. Additionally, documenation reviewed revealed licensee has plans in place to replace facility with a new structure on the property grounds by Summer 2024 which will also include new roofing. Currently no leaks are occurring at facility and licensee has demonstrated attempts to prevent leaks. As a result, the prepoderance of evidence standards is not met, and this allegation is UNFOUNDED. An exit interview was conducted with S1 and a copy of this report was provided to S1.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
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 1