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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700109
Report Date: 11/18/2022
Date Signed: 11/18/2022 12:02:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/29/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220929075450
FACILITY NAME:DELTA AT THE SHERWOODSFACILITY NUMBER:
392700109
ADMINISTRATOR:LEAH ZUBIATEFACILITY TYPE:
740
ADDRESS:1215 W SWAIN ROADTELEPHONE:
(209) 689-3180
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:42CENSUS: DATE:
11/18/2022
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Craig VinceletTIME COMPLETED:
11:32 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff pushed resident to the ground to clean up a spill
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/18/22 Licensing Program Analyst (LPA) Maja Jensen arrived at facility to contiue a complaint investigation in to the above listed allegation. LPA Jensen met with site manager Craig Vincelet and explained the purpose of today's visit.

During the course of the investigation LPA Jensen interviewed a current staff member, a former staff member, former resident 1 (R1), R1's conservator and R1's family member. LPA Jensen also reviewed all records in R1's resident file. LPA Jensen was unable to corroborate the statements made claiming that this incident was witnessed. LPA Jensen was also unable to find documentation to serve as supporting evidence that this incident occured therefore the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

No citations are being issued as a result of this investigation. An exit interview was conducted and a copy of this report and appeal rights were given to Craig Vincelet.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
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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