392700885-8-9-2023-27-AS-LKIG-CUPN2E-20230814100435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700885
Report Date: 07/24/2023
Date Signed: 08/09/2023 01:34:31 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
04/28/2023 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230428162559

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: 46	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	11:54 AM
MET WITH:	TANYA MONGE		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are over medicating residents in care.
Unqualified staff administering medications to residents.
Staff are mishandling resident's medication logs.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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

Allegation 1- Staff are over medicating residents in care, Allegation 2- Unqualified staff administering medications to residents, alleagtion 3- Staff are mishandling resident's medication logs are UNSUBSTATIATED. Based on LPA observation and interviews of S1 and also R2 R-4. 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: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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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