392701278-7-27-2023-27-AS-LKIG-CUGV7A-20230807161045

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701278
Report Date: 07/27/2023
Date Signed: 07/27/2023 03:35:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/24/2023 and conducted by Evaluator Maja Jensen

COMPLAINT CONTROL NUMBER: 27-AS-20230724163231

FACILITY NAME:	CHEROKEE RETIREMENT HOME		FACILITY NUMBER:	392701278
ADMINISTRATOR:	SINGH, JAGTAR		FACILITY TYPE:	740
ADDRESS:	4124 CHEROKEE RD		TELEPHONE:	(209) 518-1908
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95215
CAPACITY:	15	CENSUS: 12	DATE:	07/27/2023
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Jagtar Singh		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff denied visitation to residents in care

INVESTIGATION FINDINGS:

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On 7/27/23 at approximately 11:55am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to open a complaint investigation in to the above listed allegation. LPA Jensen met with Licensee Jagtar Singh and and explained the purpose of today's visit.

The facility underwent a change in ownership in July of 2023. LPA Jensen interviewed the new Licensee who advised that residents are not restricted in terms of having visitors.

LPA Jensen also interviewed 2 care providers, staff 1 (S1) and Staff 2 (S2). Both S1 and S2 indicated that visitors are not restricted.

Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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-20230724163231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: CHEROKEE RETIREMENT HOME	FACILITY NUMBER: 392701278
	VISIT DATE: 07/27/2023

NARRATIVE

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LPA Jensen interviewed 6 of 12 residents. 4 of the 6 residents indicated they do not have anyone that would visit. 2 of the 6 residents interviewed stated they do have visitors and there are no restrictions to the visitation.

During the course of this visit the facility welcomed 2 visitors that came to see the residents.

Based on interviews conducted with 2 staff members, the Licensee and 6 residents the allegation of Staff denied visitation to residents in care is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

No citations were issued as a result of this investigation.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

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