392701576-12-2-2025-27-AS-LKIG-DP7TS7-20251209135839

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701576
Report Date: 12/02/2025
Date Signed: 12/02/2025 04:02:57 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
11/05/2025 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20251105095151

FACILITY NAME:	CRYSTAL CREEK SENIOR LIVING		FACILITY NUMBER:	392701576
ADMINISTRATOR:	PUNNI,MANISHA		FACILITY TYPE:	740
ADDRESS:	2435 WAGNER HEIGHTS ROAD		TELEPHONE:	(209) 477-5353
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	80	CENSUS: 68	DATE:	12/02/2025
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Angela Riungu		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff interfered with resident’s ability to engage in religious activities.
Staff threatened resident.
Staff transported resident in an unsafe manner.
Staff did not safeguard resident’s medication.

INVESTIGATION FINDINGS:

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On 12/02/25, Licensing Program Analyst (LPA) Kesha Lewis made an unannounced visit to this facility to deliver findings about the above allegations. LPA identified herself upon arrival, stated the purpose of the visit.

Based on interviews with staff and residents along with the reporting party and documents reviewed. LPA could not find evidence that the above allegation. Two of the interviewees stated that the facility purchased items for R1 to engage in their religious activities, there is also no person that can corroborate R1 was transported in an unsafe manner or threatened. A review of R1'S medication was done, and all was found to be accounted for. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

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

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

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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