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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701177
Report Date: 04/10/2025
Date Signed: 04/10/2025 03:50:54 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
01/22/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250122083118
FACILITY NAME:TELECARE WHITE LANEFACILITY NUMBER:
392701177
ADMINISTRATOR:DANICA MORRISONFACILITY TYPE:
737
ADDRESS:1775 WHITE LANETELEPHONE:
(510) 621-9064
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY:4CENSUS: 2DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Amanda DuggiralaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff speaks inappropriately to clients
Facility staff are providing inappropriate interventions for residents
INVESTIGATION FINDINGS:
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On 4/10/2025 at 1:31pm, Licensing Program Analysts (LPAs) Michael Bilger and Noel Wolf Petersen arrived unannounced to deliver and discuss findings for the allegations noted above. LPA met with Direct Care Supervisor (DCS) Amanda Duggirala and explained the purpose of the visit. Administrator Danica Morrison was made aware of LPAs visit via phone and gave permission for DCS to sign in her absence. During this investigation, LPA conducted interviews with six staff members and reviewed facility file documentation including program design, incident report, and individual behavior support plan for resident1 (R1). Additionally, LPA conducted facility observation on 1-23-2025.

Allegation: Facility staff speaks inappropriately to clients. LPA conducted interviews and record reviews as noted above. Based on these interviews and record reviews, it was revealed through corroborated statements that facility staff were witnessed to have used inappropriate language in the presence of and directly to clients which included foul language, and verbalizations resulting in the encouragement of negative, unsafe behaviors, and an undignified environment for clients. {Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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 5
Control Number 27-AS-20250122083118
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: TELECARE WHITE LANE
FACILITY NUMBER: 392701177
VISIT DATE: 04/10/2025
NARRATIVE
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Such verbalization included but were not limited to: Facility staff verbalizing to a client he cannot watch television due to a behavior. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

Allegation: Facility staff are providing inappropriate interventions for residents. LPA conducted interviews and record reviews as noted above. Based on these interviews and record reviews, it was revealed through corroborated statements that facility staff were witnessed to exhibit interventions resulting in an unsafe and undignified environment for residents. Such interventions expressed corroboratively included but were not limited to: The act of barring a resident from watching television due to a behavior. Additional inappropriate interventions expressed through staff interviews included staff member encouraging a resident to express negative, unsafe behaviors. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

As a result of this investigation, citations are issued under Title 22, Division 6 and noted on LIC 9099D. A civil penalty in the amount of $250 is issued in addition to citation due to repeat violation of section 80072(a)(3) within a 12-month period. An exit interview was conducted with DCS and a copy of this report was provided. Appeal rights and LIC 811 provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20250122083118
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: TELECARE WHITE LANE
FACILITY NUMBER: 392701177
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2025
Section Cited
CCR
80072(a)(1)
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Personal Rights. (a)…each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
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Licensee to ensure completed staff training on resident rights including but not limited to: Use appropriate language and other elements specific to Section 80072(a)(1).
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Based on corroborated interviews, facility staff engaged in using foul and other inappropriate language towards residents. This posed a potential health, safety and resident rights risks to residents in care.
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Type B
04/21/2025
Section Cited
CCR
80072(a)(3)
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Personal Rights.(a)…each client shall have personal rights which include, but are not limited to, the following: (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature…This requirement was not met as evidence by:
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Licensee to ensure completed staff training on resident rights including but not limited to: Elements of Section 80072(a)(3)

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Based on corroborated statements, facility staff engage in utilizing punitive measures on residents due to behavior. This posed a potential health, safety, and resident rights risk to residents in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
01/22/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250122083118

FACILITY NAME:TELECARE WHITE LANEFACILITY NUMBER:
392701177
ADMINISTRATOR:DANICA MORRISONFACILITY TYPE:
737
ADDRESS:1775 WHITE LANETELEPHONE:
(510) 621-9064
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY:4CENSUS: 2DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Amanda DuggiralaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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2
3
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5
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9
Facility staff threw water on client
INVESTIGATION FINDINGS:
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On 4/10/2025 at 1:31pm, Licensing Program Analysts (LPAs) Michael Bilger and Noel Wolf Petersen arrived unannounced to deliver and discuss findings for the allegation noted above. LPA met with Direct Care Supervisor (DCS) Amanda Duggirala and explained the purpose of the visit. Administrator Danica Morrison was made aware via phone of LPAs visit and purpose and gave permission for DCS to sign in her absence. During this investigation, LPA conducted interviews with six staff members and reviewed facility file documentation including program design, incident report, and individual behavior support plan for resident1 (R1). Additionally, LPA conducted facility observation on 1-23-2025.

Allegation: Facility staff threw water on client. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was determined that on or about 1-4-2025, a facility staff member was holding a cup of water and became startled when resident1 (R1) poked head through the door.

{Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20250122083118
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: TELECARE WHITE LANE
FACILITY NUMBER: 392701177
VISIT DATE: 04/10/2025
NARRATIVE
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As a result of being startled, facility staff member threw some of the water in the air, and a portion of this water landed on resident. Interviews conducted did not reveal any corroborated statements of facility staff member intentionally and directly throwing water on client as a form of defense or punishment.

As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with DCS and a copy of this report was provided. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5