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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700769
Report Date: 07/23/2024
Date Signed: 07/24/2024 11:17:40 AM

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
05/06/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240506091900
FACILITY NAME:DELTA MANORFACILITY NUMBER:
392700769
ADMINISTRATOR:VINCELET, CRAIGFACILITY TYPE:
735
ADDRESS:1201 W. SWAIN ROADTELEPHONE:
(805) 242-0135
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:14CENSUS: 11DATE:
07/23/2024
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:F. KhanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not according privacy to resident in care.
Licensee is financially abusing resident in care.
INVESTIGATION FINDINGS:
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On 7/23/24, LPA Johnson arrived unannounced to deliver finding for the above allegations.

Allegation: Staff are not according privacy to resident in care. Based on records reviewed the department confirmed that all checks sent by Counties are addressed to the facilities' corporate address and as a result the residents that are receiving mail from these counties agencies are not afforded the right or privacy of reviewing the mail prior to it being sent to the corporate office to be cashed and placed into the residents account for distribution to the resident.

Continued
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
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 2
Control Number 27-AS-20240506091900
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: DELTA MANOR
FACILITY NUMBER: 392700769
VISIT DATE: 07/23/2024
NARRATIVE
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The residents have been missed informed at times about checks not arriving, when in actuality the checks have arrived and been forwarded to the facilities corporate office.

However, the facilities' 2024 admission agreement states that the "Internal accounting procedures do not allow for handling of check money orders and postal orders written directly to the residents."

The residents and their responsible parties signed the admissions agreement therefore agreeing to the terms of the document.

Allegation: Licensee is financially abusing resident in care. Based on records reviewed and interviews with residents the facility is following the admission agreement and provide each resident with cash that is signed for on the record of client's cash resources form. The records indicate the amount received or amount withdrawn.

The department is unable to confirm the allegations and as a result finds this complaint unsubstantiated.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2