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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700993
Report Date: 06/05/2025
Date Signed: 06/05/2025 03:26:38 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
04/09/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250409132624
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: 154DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:S. SandeepTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not prevent resident from being physically assaulted
Staff did not assist resident in a timely manner
Staff do not safeguard resident's personal belongings
Staff are not assisting resident with grooming
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Albert Johnson arrived unannounced to deliver findings for the complaint allegations noted above. LPA met with Sunny and Director of Nursing Lucky Kaur and explained the purpose of the visit.

Allegation: Staff did not prevent resident from being physically assaulted
Based on interviews conducted and records reviewed there were no witnesses to alleged event or outstanding visible injuries noted by staff. Staff was made aware by family friend of the incident and followed up to determine if R-1 was attacked or injured. Staff working confirmed that there were no visible injuries and no witnesses to alleged incident noted.

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

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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-20250409132624
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: 06/05/2025
NARRATIVE
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Allegation: Staff did not assist resident in a timely manner. Based on interviews and record reviews, it was revealed that R1 has been experiencing changes in condition and has been increasing in verbal repetition, confusion and making allegations of missing items. The family has been made aware of the situation as well as the primary care physician. On 4/11/2025, Stockton Police officers conducted a welfare check (report number P250990565) and determined that R-1's welfare is not compromised.

Allegation: Staff do not safeguard resident's personal belongings. The department reviewed the inventory record of R-1 and was able to match items from the list to actual items, however the counts were off for undergarments and socks. R-1 has been alleging that items are missing and will report these missing items to staff. Staff will locate these items and show R-1 that the items are not missing.

Allegation: Staff are not assisting resident with grooming. Records reviewed and in-person visits by the department confirmed that R-1 has been receiving assistance with daily living hygiene and has been seen by the Podiatrist on a regular bases monthly. The Podiatrist is scheduled quarterly. However, R-1 has refused treatment for the last three months.

As a result, it is determined that there is not a preponderance of evidence to prove these allegations occurred, therefore, this allegation is UNSUBSTANTIATED. An exit interview was conducted

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

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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