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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701576
Report Date: 12/02/2025
Date Signed: 12/02/2025 02:24:09 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
10/10/2025 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251010151501
FACILITY NAME:CRYSTAL CREEK SENIOR LIVINGFACILITY NUMBER:
392701576
ADMINISTRATOR:PUNNI,MANISHAFACILITY TYPE:
740
ADDRESS:2435 WAGNER HEIGHTS ROADTELEPHONE:
(209) 477-5353
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:80CENSUS: 68DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
12:13 PM
MET WITH:Angela RiunguTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff do not assist resident with arranging transportation to attend church
Staff do not allow resident access to personal belonging.
Staff do not safeguard resident's mail.
Staff do not allow resident to travel into the community.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/02/25, Licensing Program Analyst (LPA) Kesha Lewis made an unannounced visit to this facility to deliver findings about the above allegations. LPA identified herself upon arrival, stated the purpose of the visit.

Based on interviews with staff and residents along with the reporting party and documents reviewed. LPA could not find evidence that the above allegation. Interviews with state that when available the facility van was used to transport R1 and when it was not the staff offered to call uber or a cab for R1 this was confirmed their interviews. Based on LPA'S observation R1 had all their belongs and they were available to R1. Mail at the facility is called and passed out by one staff member only. Based on records reviewed R1 cannot leave the facility unassisted. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted, and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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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