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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700109
Report Date: 06/16/2025
Date Signed: 06/23/2025 12:33:47 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
03/11/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250311135925
FACILITY NAME:DELTA AT THE SHERWOODSFACILITY NUMBER:
392700109
ADMINISTRATOR:MOMO R DUOAFACILITY TYPE:
740
ADDRESS:1215 W SWAIN ROADTELEPHONE:
(209) 689-3180
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:42CENSUS: 40DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Racquel Jones -NolenTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff will not accept resident back after hospital discharge
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Albert Johnson and Ellen Lindstrom conducted an unannounced facility visit to delivery findings. LPA met with Staff and explained the purpose of today's visit. Later joined by Dr. Zubiate.

Based on the information received by the department. R1 was discharged from the facility and referred to another facility for ongoing psychiatric evaluation, medication adherence and stabilization. The hospital discharged R1 to a skilled nursing facility. The Delta Sherwood was unable to excepted R1 back due to the discharge plan written for R1 to be sent to a skilled nursing facility.

Although the allegation may have occurred as reported there was insufficient evidence to prove the allegation. The preponderance of evidence standard was not met therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report with appeal rights was given to Licensee.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
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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