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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701278
Report Date: 02/22/2024
Date Signed: 02/22/2024 04:29:54 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
02/01/2024 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20240201132049
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:
02/22/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jagtar SinghTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility premises is not kept free of fire hazards
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 2-22-24 at 2:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived at the facility unannounced to deliver findings for the allegation noted above. LPA met with Administrator Jagtar Singh and explained the purpose of the visit. Administrator was unable to stay due to a prior commitment and designated staff2 (S2) to sign in his absence. During this investigation, LPA conducted an interview with the Administrator on 2-6-24. Additionally, LPA reviewed facility photographs, and conducted a facility observation of electrical boxes (breakers) around facility grounds as well as other general areas on 2-6-24. Documentation from Community Development Department Code Enforcement was reviewed by LPA on 2-12-24.
Based on interviews, record reviews, and observation it was determined that the facility was licensed on 7-19-2023 with a valid fire clearance. It was further determined that electrical boxes were maintained from date of licensure and prior to licensure. A second fire inspection was conducted at the property on 8-17-23 which did not reveal any violations. On 2-12-24, Code Enforcement inspected the electrical boxes and determined no fire hazards existed. {Cont. on 9099C}

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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-20240201132049
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: CHEROKEE RETIREMENT HOME
FACILITY NUMBER: 392701278
VISIT DATE: 02/22/2024
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 that facility premises are not kept free of fire hazards. As a result, this allegation is UNFOUNDED. An unfounded finding means the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted with S2 and a copy of this report was provided to S2.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2