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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005071
Report Date: 09/27/2022
Date Signed: 11/04/2022 04:05:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2022 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220818161402
FACILITY NAME:SONIA'S CARE HOME 2FACILITY NUMBER:
397005071
ADMINISTRATOR:GAPASIN, SONIAFACILITY TYPE:
740
ADDRESS:8240 RICHLAND DRIVETELEPHONE:
(209) 609-9342
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 4DATE:
09/27/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Pangilalo PaltepTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff shoved resident.
Staff forced resident to take a cold shower.
Staff disposed of resident's personal items.
Staff yelled at resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Kesha Lewis and Albert Johnson made an unannounced visit to this facility today to open a complaint investigation for the allegation listed above.

Licensing Program Analysts (LPA'S) Kesha Lewis and Albert Johnson arrived at the facility to conduct an unannounced visit to conduct a complaint investigation. LPA met with facility S1 and explained the purpose of today’s visit.

Regarding the allegation that facility Staff shoved resident, Staff forced resident to take a cold shower,
Staff disposed of resident's personal items, Staff yelled at resident. LPA reviewed the residents physicians reports, IPP, Progress notes and also spoke with the residents and staff. Based on records review of R1'S IPP R1 becomes argumentative and "states they know their rights" when asked to do things they do not want to do. Based on interviews with residents and staff R1 makes up things when they do not get what they want.

Therefore, this complaint is UNSUBSTANTIATED.

A finding that the complaint 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 did or did not occur, therefore the allegation is unsubstantiated.

Per title 22 no deficiencies being cited during this visit. Exit interview conducted and a copy of this report was left at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
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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