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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700885
Report Date: 01/29/2026
Date Signed: 01/29/2026 02:33:42 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
10/21/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251021103537
FACILITY NAME:DELTA AT THE PORTSIDEFACILITY NUMBER:
392700885
ADMINISTRATOR:JOSHUA RIVERAFACILITY TYPE:
740
ADDRESS:1950 E SONORA STREETTELEPHONE:
(209) 689-3180
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY:66CENSUS: 39DATE:
01/29/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tammy I.TIME COMPLETED:
02:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not giving medication as ordered by Physician
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Johnson arrived unannounced to deliver findings for the above allegations.

Allegation: Facility staff are not giving medication as ordered by Physician. Based on records reviewed the facility is assisting R1 with the administration of medication. There was medication refusal eight times in November of 2025. After reviewing the needs and service plan for R1 and other residents the department has determined that the facility has identified service needs and uses checkmarks to determine if the need will be addressed by the facility, Physician or other a consultants. The language is not tailored to individual needs but generically written to cover the targeted need. This is also identified in the interventions for non-compliance for R1, based on this information the department is unable to determine if R1's refusal of medication / non-compliant with medications was addressed by the primary care physician the records on the medication records do not reflect alternatives or replacement guidance.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

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

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
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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