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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005071
Report Date: 02/06/2024
Date Signed: 02/06/2024 02:50:52 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
01/31/2024 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240131163521
FACILITY NAME:SONIA'S CARE HOME 2FACILITY NUMBER:
397005071
ADMINISTRATOR:GAPASIN, SONIAFACILITY TYPE:
740
ADDRESS:8240 RICHLAND WAYTELEPHONE:
(209) 609-9342
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 5DATE:
02/06/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Criselda PaltepTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not clean resident’s room.
INVESTIGATION FINDINGS:
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LPA Kesha Lewis made an unannounced visit to this facility today to open a complaint investigation for the allegation listed above. LPA met with facility staff and explained the purpose of today’s visit.

Allegations: Staff did not clean resident’s room. After reviewing R1'S room, speaking with RP and interviews with residents and staff regarding the allegation LPA Lewis finds the complaint to be unsubstantiated.

LPA toured R1'S room and there was not noticable smeels, room was vacumed and apeared clean. Therefore, this complaint is UNSUBSTANTIATED. A finding that a 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.

Exit interview conducted. copy of report given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
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 3
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
01/31/2024 and conducted by Evaluator Kesha Lewis
COMPLAINT CONTROL NUMBER: 27-AS-20240131163521

FACILITY NAME:SONIA'S CARE HOME 2FACILITY NUMBER:
397005071
ADMINISTRATOR:GAPASIN, SONIAFACILITY TYPE:
740
ADDRESS:8240 RICHLAND WAYTELEPHONE:
(209) 609-9342
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 5DATE:
02/06/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Criselda PaltepTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Resident’s dresser is in disrepair.
INVESTIGATION FINDINGS:
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Allegations: Resident’s dresser is in disrepair. After reviewing R1'S room, speaking with RP and interviews with residents and staff regarding the allegation LPA Lewis finds the complaint to be SUBSTANTIATED.

During the the LPA'S tour of R1'S room there was a large dresser in the room that had pulled off old stickers on it and some small holes along with stains (photos taken). Based on these observations the allegation is SUBSTANTIATED.

As a result, the preponderance of evidence standard is not met, and this allegation is SUBSTANTIATED.

Exit interview conducted. copy of report given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20240131163521
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: SONIA'S CARE HOME 2
FACILITY NUMBER: 397005071
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2024
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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The facility will repair or replace the dresser in R1'S room by the POC date or provide the department with a plan to repair or replace the unit by 2/16/2024.
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This requirement is not met as evidenced by LPA observation of R1'S room. This is a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3