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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701177
Report Date: 07/17/2025
Date Signed: 07/17/2025 11:37:44 AM

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
05/05/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250505124733
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: 3DATE:
07/17/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Amanda DuggiralaTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility staff did not seek timely medical attention for client
INVESTIGATION FINDINGS:
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On 7-17-25 at 10:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegation noted above. LPA met with direct care supervisor Amanda Duggirala and explained the purpose of the visit. During this investigation, LPA conducted interviews with three staff members, and reviewed facility file documentation including individual behavior support plan (IBSP) for resident1 (R1), blood pressure log for R1, staff training records, needs and service plan for R1, medication lists for R1, individual program plan (IPP) for R1, facility program plan, and facility incident report dated 5-5-2025. Based on interviews and record reviews, it was revealed that on 5-2-2025 beginning at 10:00pm, R1 experienced a total of four high blood pressure readings taken by staff on duty. Staff on duty communicated with physician for support who informed staff after a third high blood pressure reading at 10:30pm to take R1 to urgent care.

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

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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-20250505124733
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: 07/17/2025
NARRATIVE
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Record reviews and interviews further revealed that due to urgent care centers not open, facility staff arranged for and transported R1 to emergency room at a local hospital at approximately 11:15pm. Prior to leaving for the hospital, facility staff took a fourth blood pressure test for R1 which resulted in an additional high reading. It was further revealed through interviews and record reviews that staff was aware of R1’s history of high blood pressure. As a result of the time frame between the initial discovery of high blood pressure, the communication with the physician and actual time of R1 taken to emergency room by facility staff for treatment, it is determined that the preponderance of evidence standard is met, therefore , this allegation is SUBSTANTIATED. Citation is 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 80078(a) within a 12-month period.

An exit interview was conducted with direct care supervisor 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: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20250505124733
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: 07/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2025
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
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Licensee will ensure completed staff training by an outside vendor on appropriate and timely response to emergency situations regarding resident medical needs. Proof of scheduled training to be sent to LPA by POC due date. Staff training to be completed no later than 7-31-2025.
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Based on interview and record review, licensee did not ensure the timely medical treatment of R1. This posed an immediate health and safety risk for resident in care.
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Licensee will submit a plan outlining procedures regarding identification of resident medical emergencies and protocols for response. Plan to be submitted to LPA by POC due date.
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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: 07/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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
05/05/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250505124733

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: 3DATE:
07/17/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Amanda DuggiralaTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff are not adequately trained
Staff are not maintaining appropriate records for a client
INVESTIGATION FINDINGS:
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On 7-17-25 at 10:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegations noted above. LPA met with direct care supervisor Amanda Duggrala and explained the purpose of the visit. During this investigation, LPA conducted interviews with three staff members, and reviewed facility file documentation including individual behavior support plan (IBSP) for resident1 (R1), blood pressure log for R1, various staff training records, needs and service plan for R1, medication lists for R1, individual program plan (IPP) for R1, facility program plan, and facility incident report dated 5-5-2025. Based on interviews and record reviews, it was revealed that R1 sustained a series of high blood pressure readings resulting in hospitalization.
Allegation: Staff are not adequately trained. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that staff completed various training topics between 2024 and 2025 which included topics covering regulatory requirements as well as Telecare’s internal expectations for training. {Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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-20250505124733
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: 07/17/2025
NARRATIVE
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Additionally, it was revealed that staff have received additional training on blood pressure procedures between the dates of 4-28-2025 and 5-20-2025. As a result, there is not a preponderance of evidence to conclude that staff have not received adequate training, therefore this allegation is UNSUBSTANTIATED.

Allegation: Staff are not maintaining appropriate records for a client. LPA conducted interviews and record reviews as noted above. This allegation is related to the blood pressure incident described above. Based on interviews and record reviews, it was revealed that facility staff maintained blood pressure readings in logs for R1 between 4-15-2025 and 5-5-2025 with noted facility procedures for blood pressure readings to be taken two times daily. These blood pressure readings were noted in logs reviewed. Additional appropriate regulatory required records were also maintained in R1’s record during review. As a result, there is a not a preponderance of evidence to conclude staff are not maintaining appropriate records for resident in care, therefore 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 direct care supervisor and a copy of this report was provided. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5