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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397002983
Report Date: 12/01/2021
Date Signed: 12/01/2021 02:48:55 PM

Unfounded


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
09/16/2021 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20210916101243
FACILITY NAME:COUNTRY PALMS CARE HOMEFACILITY NUMBER:
397002983
ADMINISTRATOR:TRIPLETT, JOSEPH J.FACILITY TYPE:
740
ADDRESS:2905 BRISTOL AVENUETELEPHONE:
(209) 462-1135
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:6CENSUS: 5DATE:
12/01/2021
UNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:Joseph TriplettTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mishandled funds
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12-1-21 at 2:12pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegation listed above. LPA met with Administrator Joseph Triplett and explained the purpose of the visit. During this investigation, auditor reviewed facility file documentation including LIC 405 and obtained police reports containing interviews for client1 (C1) and C2. Auditor also reviewed facility account ledgers containing various transactions involving C1 and C2. Auditor also conducted interviews with regional center representative. LPA reviewed Auditor report. Based on records reviews submitted to LPA and interviews conducted by auditor, it is determined that the licensee was not out of compliance with Title 22 regulation regarding the staff mishandling of client funds. Facility and payee ledgers were reviewed by auditor for client deposits and the funds were accounted for in the period reviewed.

Based on the information received by LPA, this allegation is UNFOUNDED.
An exit interview was conducted with Joseph Triplett and a copy of this report was left with Joseph.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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