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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701374
Report Date: 12/11/2024
Date Signed: 12/11/2024 11:07:34 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
11/06/2024 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20241106095508
FACILITY NAME:CHEROKEE RETIREMENT HOME INCFACILITY NUMBER:
392701374
ADMINISTRATOR:SINGH, JAGTARFACILITY TYPE:
740
ADDRESS:4124 CHEROKEE ROADTELEPHONE:
(209) 518-1908
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY:15CENSUS: 12DATE:
12/11/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jagtar SinghTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility is in disrepair
Administrator is not present
INVESTIGATION FINDINGS:
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On 12-11-24 at 10:15am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss the complaint allegations noted above. LPA met with Administrator Jagtar Singh and explained the purpose of the visit. During this investigation, LPA conducted interviews with three clients in care and two staff members. LPA also conducted facility observations on 11-7-24 and 12-11-24. LPA also reviewed facility file documentation including current staff schedule.

Allegation: Facility is in disrepair. LPA conducted interviews and observations as noted above. Based on interviews and observation, it was determined that various items necessary for general operation of the facility are functioning properly including but not limited to: Heating and air units, kitchen items, smoke detectors, and faucet units. Additionally, it was revealed that facility, though aging, has made past necessary repairs and continues on-going assessments for any future repairs as necessary.

{Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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-20241106095508
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: CHEROKEE RETIREMENT HOME INC
FACILITY NUMBER: 392701374
VISIT DATE: 12/11/2024
NARRATIVE
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Interviews and observations further determined that central heat and air covers the original portion of the house while an additional portion of the house, added thereafter is equipped with wall units and portable heating and air units all determined to be functioning properly at this time. As a result, there is not a preponderance of evidence to conclude facility is in disrepair currently, therefore this allegation is UNSUBSTANTIATED.

Allegation: Administrator is not present. LPA conducted interviews, observations, and record reviews as noted above. Based on interviews, it was determined that Administrator is observed to be on-site at least 20 hours per week and address resident concerns upon requests. An observation conducted by LPA determined Administrator presence and availability to resident needs. A review of staffing schedule revealed regular Administrator hours and availability between 9am to 5pm Monday thru Friday and additional hours as needed Saturday and Sunday 11am to 4pm. As a result, there is not a preponderance of evidence to conclude that Administrator is not present and available for facility and resident needs. As a result, 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 Administrator and a copy of this report was provided to Administrator. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2