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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700539
Report Date: 11/20/2025
Date Signed: 11/20/2025 11:59:35 AM

Substantiated


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
11/03/2025 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251103130848
FACILITY NAME:CHAMPION RESIDENTIALFACILITY NUMBER:
392700539
ADMINISTRATOR:BOYD, JAMESHAFACILITY TYPE:
735
ADDRESS:481 SPRING RIVER CIRCLETELEPHONE:
(510) 815-8570
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:4CENSUS: 4DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Vanessa OrtezTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff do not treat clients with dignity or respect
INVESTIGATION FINDINGS:
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On 11-20-2025 at 10:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with house manager Vanessa Ortez and explained the purpose of the visit. Administrator Jamesha Boyd was made aware of LPA's visit and purpose via phone. During this investigation, LPA conducted interviews with three residents and three staff. LPA also reviewed facility file documentation including physician’s reports, individual program plans, and form SOC 341 pertaining to this investigation.
Allegation: Staff do not treat clients with dignity or respect. LPA conducted interviews and record reviews as noted above. Based on interview and record reviews including a report and internal investigation generated by Licensee on or about 11-4-2025, it was revealed that a staff member made inappropriate comments towards a resident which resulted in an uncomfortable environment for the resident. Such verbalizations, based on the facility’s report, were described as attempts to control resident’s social interactions, use of threatening language, and emotional manipulation. {Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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 5
Control Number 27-AS-20251103130848
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: CHAMPION RESIDENTIAL
FACILITY NUMBER: 392700539
VISIT DATE: 11/20/2025
NARRATIVE
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Licensee concluded these events occurred and as a result, terminated the staff member involved citing an attempt to promote a safe environment for residents in care. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6 and noted on LIC 9099D. An exit interview was conducted with house manager, and a copy of this report was provided. Appeal rights and LIC 811 provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20251103130848
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: CHAMPION RESIDENTIAL
FACILITY NUMBER: 392700539
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2025
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights. (a) …each client shall have personal rights which include, but are not limited to, the following: (3) To be free from…humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature…This requirement was not met as evidenced by:
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Licensee will ensure completed staff training on resident rights which shall include but not be limited to contents noted in Section 80072(a)(3). Proof of completed training to be sent to LPA by POC due date.

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Based on interview and record review, Licensee did not ensure a resident free from verbal intimidation and threats. This posed 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: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
11/03/2025 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251103130848

FACILITY NAME:CHAMPION RESIDENTIALFACILITY NUMBER:
392700539
ADMINISTRATOR:BOYD, JAMESHAFACILITY TYPE:
735
ADDRESS:481 SPRING RIVER CIRCLETELEPHONE:
(510) 815-8570
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:4CENSUS: 4DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Vanessa OrtezTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff isolated clients in their rooms
Staff allowed their minor child to interfere with client's care
INVESTIGATION FINDINGS:
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On 11/20/2025 at 10:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegations noted above. LPA met with house manager Vanessa Ortez and explained the purpose of the visit. Administrator Jamesha Boyd was made aware of LPA's visit and purpose via phone. During this investigation, LPA conducted interviews with three residents and three staff. LPA also reviewed facility file documentation including physician’s reports and individual program plans.
Allegation: Staff isolated clients in their rooms. LPA conducted interviews and record reviews as noted above. Based on interviews conducted, it was revealed that although certain residents desire their own room environment, no corroborated statements or additional evidence existed to determine that residents were involuntarily isolated in their rooms by way of staff preference. Interviews conducted also revealed that residents are encouraged to spend more time outside of room for socialization with peers.

{Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20251103130848
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: CHAMPION RESIDENTIAL
FACILITY NUMBER: 392700539
VISIT DATE: 11/20/2025
NARRATIVE
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A review of documentation revealed on-going interventions to increase socialization with peers. As a result, there is not a preponderance of evidence to conclude staff isolated clients in their rooms, therefore this allegation is UNSUBSTANTIATED.

Allegation: Staff allowed their minor child to interfere with client’s care. LPA conducted interviews as noted above. Based on interviews conducted, it was revealed that Licensee on occasion has brought her minor children to facility briefly. It was further revealed that children resided in Licensee’s office and supervised without interaction with residents in care. Additionally, interviews conducted did not reveal corroborated statements or evidence to conclude additional children have been present which interrupted or infringed on residents’ care and rights. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.
A finding of UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.
An exit interview was conducted with house manager, and a copy of this report was provided. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5