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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701318
Report Date: 12/23/2024
Date Signed: 12/24/2024 09:19:21 AM

Substantiated


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
12/13/2024 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241213130436
FACILITY NAME:ESTEEMED RESIDENTIAL CARE 2FACILITY NUMBER:
392701318
ADMINISTRATOR:WALTERS, CHRISTOPHERFACILITY TYPE:
735
ADDRESS:2431 ETCHEVERRY DRIVETELEPHONE:
(925) 219-2787
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:4CENSUS: 4DATE:
12/23/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Leon Tambai and Blamasee Sarnoa JrTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility over licensed capacity
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 12/23/2024 by Licensing Program Analyst (LPA) Charlie Yang who met by the facility staff, Leon Tambai and Blamasee Sarnoa Jr, and a brief interview was conducted with the facility staff at this time.
The purpose of this visit was to inform this facility, and its representative, that a complaint had been filed with the above allegation at this time. It was also the intent of this visit to deliver findings as well upon completion of this investigation to this facility, and its representative, at this time.
This LPA requested that the facility staff person go ahead and contact the facility designated Administrator, Christopher Walters, to inform him that CCL was present at this time for a complaint visit.
This LPA held an interview with the facility designated Administrator, Christopher Walters, over the phone and discussed the details surrounding the above allegation.
Current census was 4 residents, of which all 4 residents, were out of the facility at their respective day programs at this time.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
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 3
Control Number 27-AS-20241213130436
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: ESTEEMED RESIDENTIAL CARE 2
FACILITY NUMBER: 392701318
VISIT DATE: 12/23/2024
NARRATIVE
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Based on a review of the forms and documents submitted into CCL by this facility, and its representative, it was learned that a request was made to change the capacity from 4 residents to the ability to accept and retain up to 5 residents at any given time.
It was learned that on 11/26/2024 a request was made from this facility to raise the capacity from 4 to 5 residents with the submission of an LIC 200 and the facility sketch.
It was learned that on 12/09/2024 inquiries were made by this facility to check up on the status of the capacity increase via email.
It was learned that on 12/10/2024 the fire clearance was granted for the capacity increase and the facility Licensee was notified of the approval to be made effective on 12/11/2024 to be able to accept and retain up to 5 residents at any given time.
Based on interviews and a review of additional forms and documents, it was learned that this facility accepted and retained an additional resident from 11/04/2024 to 11/27/2024 which would have meant that this facility was over capacity since there were already 4 residents in care at that time. This facility, at that time, was only licensed to be able to accept and retain 4 residents at any given time but went ahead and accepted a fifth resident.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

A civil penalty of $500 was levied at this time.

Appeal rights were printed and a copy was left with the facility designated representative Blamasee Sarnoa Jr at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20241213130436
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: ESTEEMED RESIDENTIAL CARE 2
FACILITY NUMBER: 392701318
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/24/2024
Section Cited
CCR
80010(a)
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A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including the capacity limitation.
This facility was found to be deficient as evidenced by the acceptance of a fifth resident even though this facility was only licensed to be able to accept and retain a
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This facility, and its representative, did already submit the request for an increase in the capacity from 4 to 5 residents. All forms and documents were submitted and reviewed with an approval from the fire department.
There will not be a plan of correction due at this time.
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max capacity of 4 residents. This posed an immediate threat to the Health, Safety, and Personal Rights of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3