392700993-10-3-2024-27-AS-KHOS-DBMPVX-20241204103951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 10/03/2024
Date Signed: 10/03/2024 06:53:45 PM

Unfounded

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
08/27/2024 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240827092029

FACILITY NAME:	A1 DEL MONTE STOCKTON		FACILITY NUMBER:	392700993
ADMINISTRATOR:	SANDEEP SAINI		FACILITY TYPE:	740
ADDRESS:	517 E. FULTON STREET		TELEPHONE:	(209) 910-5910
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY:	158	CENSUS: 156	DATE:	10/03/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	S. Sandeep		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff did not ensure the facility was free from bedbugs.

INVESTIGATION FINDINGS:

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“On April 16th, 2024 the facility DON/AED had emailed LPA and self reported concerns about bed bugs in the facility based upon our regular facility inspection.” The facility provided proof that treatments to all suspected rooms were conducted the same day of self-reporting. You also advised that residents stayed in alternative rooms until treatment was completed and adhered to the recommended time frame the exterminator recommended for residents to remain out of the area for safety and health precaution.

During the investigation it was determined that through record reviews and interviews, the facility is addressing the situation by maintaining an exterminator contract to provide routine bed bug treatment service. Based on this information the allegation is unfounded

Unfounded

Estimated Days of Completion: 0

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

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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