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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700908
Report Date: 10/23/2024
Date Signed: 10/23/2024 03:23:17 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
09/10/2024 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240910134824
FACILITY NAME:ST. TIMOTHY'S HOMEFACILITY NUMBER:
392700908
ADMINISTRATOR:ALMENDRALA, MARIAFACILITY TYPE:
740
ADDRESS:9230 LARIAT LANETELEPHONE:
(650) 267-3248
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:6CENSUS: 6DATE:
10/23/2024
UNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Dave GorbonTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee is financially abusing resident in care
INVESTIGATION FINDINGS:
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On 10/23/2024 at 2:50pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the allegation noted above. LPA met with lead caregiver Dave Gorbon and explained the purpose of the visit. Administrator Maria Almendrala was not on site and gave permission via phone for lead caregiver to sign in her absence. During this investigation, LPA conducted interviews with Licensee (S1) and resident1 (R1). LPA also reviewed facility file documentation including needs and services plan, admissions agreement, and physician’s report all pertaining to R1. Additionally, LPA reviewed redacted financial documents submitted by Licensee.

Allegation: Licensee is financially abusing resident in care. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was determined that R1 was admitted to facility on 5/21/24, and a stopped payment for a check written by R1 for $2800 was initiated by R1’s bank shortly after admission after the bank was told by R1 that R1 could not recall the reason for the written check.
{Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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 2
Control Number 27-AS-20240910134824
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: ST. TIMOTHY'S HOME
FACILITY NUMBER: 392700908
VISIT DATE: 10/23/2024
NARRATIVE
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It was further determined through interviews and record reviews that this check was for R1’s partial payment of rent and supplies for R1s residency from 5/21/24 to 5/31/24. Interviews also revealed that Licensee accompanied R1 to the bank at R1’s request after learning of the stopped payment, and Licensee was seeking a new amount of $3800 to cover the full amount for rent and supplies from 5/21/24 to 6/21/24 instead of the original request for the partial payment as stated above. A review of R1’s admissions agreement revealed rent and supplies amount charges were consistent with Licensee’s charges as requested above. A review of financial documents submitted by Licensee revealed charges consistent with those stated in the admission agreement for rent and supplies from May 2024 to current. Licensee submitted redacted cashier’s checks indicating amounts for rent and supplies, and a review of invoices for R1’s rent and supplies matched the amounts written on the cashier’s checks. A review of the invoices and cashier’s checks, and interviews conducted did not reveal any additional unauthorized charges or requested amounts. An interview with Licensee revealed Licensee originally stated in May 2024 while at the bank with R1 that it would have been easier for R1 to write a check for the rent and make it out to Licensee personally due to current facility bank account issues. A review of correspondence between Licensee and Licensee’s bank confirmed that in May 2024, facility’s bank account activity was suspended due to security issues. A review of R1’s current physician’s report and needs and service plans do not indicate a cognitive decline for R1. Interview conducted with R1 did not reveal an accusation of financial abuse perpetrated by Licensee.

As a result, there is a not a preponderance of evidence to conclude Licensee was financially abusing resident, therefore this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with lead caregiver and a copy of this report was provided to lead caregiver. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2