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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 03/05/2025
Date Signed: 03/10/2025 11:42:08 AM

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
11/27/2024 and conducted by Evaluator Albert Johnson
COMPLAINT CONTROL NUMBER: 27-AS-20241127160259
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: DATE:
03/05/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:L KaurTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Facility staff is not meeting dietary needs of residents.
Facility staff is not providing adequate care of residents
Facility staff is not safeguarding resident personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Albert Johnson arrived at facility unannounced to deliver complaint investigation findings.

Allegation: Facility staff is not meeting dietary needs of residents. Based on interviews with staff and residents along with records reviewed the department was unable to substantiate that resident's dietary needs were not met. Interviews conducted confirmed that residents have received meals in their rooms and are offered options when the items on the menu are not what they prefer. The review of records included menus, dietary assessments and intervention, weight monitoring, dietary modifications. These records were part of a quarterly report provided by a registered dietitian. The allegation is unsubstantiated.

Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
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-20241127160259
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: 03/05/2025
NARRATIVE
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Allegation: Facility staff is not providing adequate care of residents. Records reviewed and interviews conducted with residents and staff provided the department with information for each resident including individual service plans, shower schedules, and care notes. This information documents overall care and supervision for residents. Based on the above information the department is not able to substantiate the above allegation.

Allegation: Facility staff is not safeguarding resident personal belongings. Based on interviews with residents and Staff, the facility is following the theft and loss policy outlined in the resident handbook. The loss of items is not taken lightly and immediate action has been taken to remedy any missing or lost item. The facility has a lost and find area as well as an area for residents to obtain additional clothing ,shoes and other personal items they may be without or in need of. Based on the above information the department is not able to substantiate the above allegation.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2