392700885-7-24-2023-27-AS-LKIG-CUCMHS-20230803093802

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700885
Report Date: 07/24/2023
Date Signed: 07/24/2023 03:48:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
04/19/2023 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230419085653

FACILITY NAME:	DELTA AT THE PORTSIDE		FACILITY NUMBER:	392700885
ADMINISTRATOR:	LO, SUSAN		FACILITY TYPE:	740
ADDRESS:	1950 E SONORA STREET		TELEPHONE:	(209) 689-3180
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95205
CAPACITY:	66	CENSUS: 44	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Laura Li		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not ensure that food is stored in a safe and healthful manner
Staff do not assist residents with meeting medical needs
Staff did not prevent resident from being injured by another resident
Staff do not seek medical attention for residents in a timely manner

INVESTIGATION FINDINGS:

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2
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Licensing Program Analyst (LPA'S) Kesha Lewis and Maja Jenson arrived at the facility unannounced to deliver findings for a complaint for the above allegations. LPA's was greeted by staff and explained the reason for the visit

Allegation 1Staff do not ensure that food is stored in a safe and healthful manner, Allegation 2- Staff do not assist residents with meeting medical needs, alleagtion 3- Staff did not prevent resident from being injured by another resident and alleagation 4- Staff do not seek medical attention for residents in a timely manner iare UNSUBSTATIATED. Based on LPA observation and interviews of S1 and also R1-R2 LPA was not able to find the allegation did or did not occur. Due to the information gathered LPA finds allegation to be UNSUBSTATIATED. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was left

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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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