397003946-4-9-2021-27-AS-SRIN-C25R53-20210416124227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397003946
Report Date: 04/09/2021
Date Signed: 04/09/2021 10:07:53 AM

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
10/19/2020 and conducted by Evaluator Ruth Wallace

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20201019140244

FACILITY NAME:	ALCOR GUEST HOME II		FACILITY NUMBER:	397003946
ADMINISTRATOR:	POIER, CORAZON		FACILITY TYPE:	740
ADDRESS:	5555 PATTI LYNN WAY		TELEPHONE:	(209) 478-9804
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95212
CAPACITY:	6	CENSUS: 2	DATE:	04/09/2021
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Telephone - Licensee/Administrator Corazon Poier Due to Precautions for COVID-19		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff do not allow residents to have private phone calls
Facility staff are not informing resident's authorized representative of medical appointments
Facility staff yell at resident
Facility staff do not allow residents to choose their clothing to wear
Facility staff are sleeping in resident's rooms

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Wallace contacted the facility via telephone to conclude a complaint investigation due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the allegations with the Licensee/Administrator.

LPA interviewed ex resident (R1), staff, administrator, family members, service coordinator, and conservator. LPA reviewed all medical, admissions, physician's reports, and administrative documents for residents.

It was alleged that facility staff do not allow residents to have private phone calls. The phone is portable and can be moved into each resident's room. Facility staff interviewed denied residents not being able to have private phone conversations and stated residents usually go into their rooms. Other interviews reported hearing that residents did not have private phone calls but there is no evidence. Based on the information provided through interviews, the allegation that facility staff do not allow residents to have private phone calls is UNSUBSTANTIATED.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021

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-20201019140244

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: ALCOR GUEST HOME II	FACILITY NUMBER: 397003946
	VISIT DATE: 04/09/2021

NARRATIVE

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Continued from 9099 - Page 2

It was alleged that facility staff are not informing resident's authorized representative of medical appointments. Staff interviewed denied or had no knowledge of facility not informing resident's authorized representative of medical appointments. Other interviews reported that resident's authorized representative was not notified of medical appointments, but there is no evidence. Based on the information provided through interviews, the allegation that facility staff are not informing resident's authorized representative of medical appointments is UNSUBSTANTIATED.

It was alleged that facility staff yell at resident. Staff interviewed denied or had no knowledge of facility staff yelling at resident. Other interviews reported facility staff yell at resident, but there is no evidence. Based on the information provided through interviews, the allegation that facility staff yell at resident is UNSUBSTANTIATED.

It was alleged that facility staff do not allow residents to choose their clothing to wear. During the interview process all except for two stated residents choose their own clothing to wear. Staff do lay the clothes out on the beds or help put clothing on residents based on their abilities. Based on the information provided through interviews, the allegation that facility staff do not allow residents to choose their clothing to wear is UNSUBSTANTIATED.

It was alleged that facility staff are sleeping in resident's rooms. Two live in staff share a staff bedroom and a private bathroom. There also is no evidence of other residents or staff from another one of licensee's facilities staying at Alcor Guest Home II. Based on the information provided through interviews, the allegation that facility staff are sleeping in resident's rooms is UNSUBSTANTIATED.

Therefore; the allegations are deemed UNSUBSTANTIATED. There was not a preponderance of evidence to prove or disprove that the allegations occurred as reported therefore the allegations were found to be Unsubstantiated.

An exit interview was conducted with Licensee/Administrator via telephone and a copy of this report LIC 9099, 9099-C, 811, 858, and Appeal Rights was provided to the Licensee/Administrator via email and an electronic email read receipt confirms receiving these documents. Licensee/Administrator will send 9099, 9099-C back via email signed to LPA Wallace.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
10/19/2020 and conducted by Evaluator Ruth Wallace

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20201019140244

FACILITY NAME:	ALCOR GUEST HOME II		FACILITY NUMBER:	397003946
ADMINISTRATOR:	POIER, CORAZON		FACILITY TYPE:	740
ADDRESS:	5555 PATTI LYNN WAY		TELEPHONE:	(209) 478-9804
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95212
CAPACITY:	6	CENSUS: 2	DATE:	04/09/2021
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Telephone - Licensee/Administrator Corazon Poier Due to Precautions for COVID-19		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff did not provide resident's authorized representative a copy of the resident's records

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Wallace contacted the facility via telephone to conclude a complaint investigation due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the allegation with the Licensee/Administrator.

It was alleged that facility staff did not provide resident's authorized representative a copy of the resident's records. Based on LPA interview and review of documents LPA did not find the time line unreasonable when R1 moved out of facility in October of 2020. The Physician's Report and other documents were provided to conservator within a couple of weeks of resident (R1) moving to a new facility to live. Licensee provided documentation, therefore the allegation was deemed UNFOUNDED. This agency has investigated the allegation noted above. The complaint allegation was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. The Department therefore has dismissed the allegation.

An exit interview was conducted with Licensee/Administrator via telephone and a copy of this report LIC 9099-A and Appeal Rights was provided to the Licensee/Administrator via email and an electronic email read receipt confirms receiving these documents. Licensee/Administrator will send 9099-A back via email signed to LPA Wallace.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3