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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700885
Report Date: 03/17/2026
Date Signed: 03/18/2026 02:58:30 PM

Substantiated


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
06/05/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250605103303
FACILITY NAME:DELTA AT THE PORTSIDEFACILITY NUMBER:
392700885
ADMINISTRATOR:MOMO R DUOAFACILITY TYPE:
740
ADDRESS:1950 E SONORA STREETTELEPHONE:
(209) 689-3180
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY:66CENSUS: 35DATE:
03/17/2026
UNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Tammy IsamTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Questionable death
INVESTIGATION FINDINGS:
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LPA Johnson conducted a complaint visit to this facility to deliver findings for the above allegation.

Allegation: Neglect/Lack of Supervision: Due to staff neglect/lack of supervision, R1 was AWOL and found deceased.

Finding: Substantiated Conclusion: R1's death certificate listed R1’s cause of death as Acute Methamphetamine with Cirrhosis of the liver listed as another significant condition contributing to death. R1’s date of death is listed as 06/02/2025.

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

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
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-20250605103303
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 AT THE PORTSIDE
FACILITY NUMBER: 392700885
VISIT DATE: 03/17/2026
NARRATIVE
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Former facility Staff (S1) reported that they saw R1 go to dinner on 05/31/2025 between approximately 1700 hours to 1800 hours. S1 took her hour long break, and returned to conduct room checks. Between approximately 1900 hours and 2000 hours, S1 looked for R1 but could not find him, so she notified former Administrator Aria Alaghemand.

S2 marked that R1 did not receive his evening medication that occurs at 2000 hours on 05/31/2025. S2 failed to report the incident and was terminated. Administrator did not notify law enforcement that R1 was AWOL until 1543 hours on 06/01/2025, although he learned about his AWOL on 05/31/2005 at approximately 2237 hours.

R1 should have been reported missing “immediately.” R1’s physician report noted that R1 is to not leave the facility unassisted. Chief Operating Officer Madison Fetyko reported that the facility staff did not follow proper policy and procedures.

Therefore, the allegation is substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiency was cited on a 809-D page, on 6/03/2025 during a case management visit regarding the same incident.

The facility Administrator was informed that an additional civil penalty was pending review during the 6/3/2025 case management visit and may be assessed according to Health and Safety Code § 1569.49(e). Once a civil penalty has been determined, the Department will return at a future date to assess civil penalty.

Exit interview conducted and report provided. Appeals rights printed
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2