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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700885
Report Date: 03/06/2024
Date Signed: 03/06/2024 12:35:04 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
02/27/2024 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20240227153938
FACILITY NAME:DELTA AT THE PORTSIDEFACILITY NUMBER:
392700885
ADMINISTRATOR:TANYA MONGEFACILITY TYPE:
740
ADDRESS:1950 E SONORA STREETTELEPHONE:
(209) 689-3180
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY:66CENSUS: 52DATE:
03/06/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Leah Zubiate, Director of Clinical Relations TIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not treat resident with respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/06/2024 at 09:30 AM, Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced facility visit to open a complaint investigation. LPA Campbell met with Leah Zubiate, Director of Clinical Relations and explained the purpose of today's visit.
It was alleged that staff did not treat residents with respect. Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated. LPA Campbell conducted an interview with the reporting party (RP) who requested that the complaint be retracted. The RP stated they were having a bad day and that they can no longer remember the details of the inciting incident. Also, of the 5 residents interviewed, LPA Campbell received no reports that staff had not treated them with respect.

Therefore, the above listed allegation is found to be UNSUBSTANTIATED. UNSUBSTANTIATED complaint findings mean that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies issued per Title 22 regulations. Exit Interview. Copy of report provided to facility representative.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
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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