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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 11/15/2024
Date Signed: 11/20/2024 12:13:38 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
10/02/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241002085320
FACILITY NAME:A1 DEL MONTE STOCKTONFACILITY NUMBER:
392700993
ADMINISTRATOR:SANDEEP SAINIFACILITY TYPE:
740
ADDRESS:517 E. FULTON STREETTELEPHONE:
(209) 910-5910
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:158CENSUS: 153DATE:
11/15/2024
UNANNOUNCEDTIME BEGAN:
01:32 PM
MET WITH:L KaurTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility has scabies
Facility staff is not following infection control precautions
Facility staff did not inform responsible party of resident's change in condition
INVESTIGATION FINDINGS:
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Allegation:Facility has scabies. LPA conducted interviews with staff and residents as noted above, and reviewed facility file documentation. Based on interviews and record reviews, it was determined that although a rash was existent on resident1 (R1) it was undetermined and unconfirmed through an appropriate skilled professional that said rash was scabies. Additionally, record review revealed treatment practices were in place for the diagnosed skin rash, and that no cases of scabies have been diagnosed at this time. Based on interviews and record reviews, there is not a preponderance of evidence to conclude that residents in care contained scabies, and this allegation is UNSUBSTANTIATED.

Continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
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-20241002085320
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: A1 DEL MONTE STOCKTON
FACILITY NUMBER: 392700993
VISIT DATE: 11/15/2024
NARRATIVE
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Allegation Facility staff is not following infection control precautions. LPA conducted facility observation on 9/14/2024, 10/15/2024 and 11/4/2024, and conducted interviews with staff and residents, and reviewed additional documentation. Based on observation and interviews, it was determined that although the facility was treated for a skin conditions the prescribing doctor did not diagnosis a case of scabies. As a result, there is not a preponderance of evidence to conclude that Facility staff is not following infection control precautions, therefore this allegation is UNSUBSTANTIATED.

Allegation: Facility staff did not inform responsible party of resident's change in condition. The department interviewed the RP and the facility staff. The RP stated that she was not informed of the change in condition and the staff at the facility stated that R1 had identified condition identified in the pre appraisal. As a result, there is not a preponderance of evidence to conclude. therefore this allegation is UNSUBSTANTIATED.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2