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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701177
Report Date: 08/07/2025
Date Signed: 08/07/2025 03:53:58 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
07/01/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250701124404
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:
08/07/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Christina ManceTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not provide proper food service to client in care
There is no qualified administrator present at the facility
Staff spoke inappropriately in front of clients in care
INVESTIGATION FINDINGS:
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On 8-7-2025 at 12:30pm, Licensing Program Analyst (LPA) and Licensing Program Manager (LPM) Liza King met with Licensee designees Christina Mance and Amanda Duggirila via Teams Meeting to deliver findings for the allegations noted above. During the course of this investigation, LPA conducted interview with staff1 (S1) and reviewed report from an external agency providing witnessing accounts. Additionally, LPA reviewed facility’s menu.
Allegation: Staff did not provide proper food service to client in care. LPA conducted interview and record review as noted above. Based on evidence presented through external reporting, it was revealed that on 6-26-2025, resident1 (R1) was observed eating chicken and rice directly off the table with his hands and no plate or utensils provided by staff. Additionally, evidence revealed that facility staff were seen scraping remaining food into the trash using a paper towel. As a result, there is a preponderance of evidence to conclude that R1 did not receive proper food service, therefore this allegation is SUBSTANTIATED.

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

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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 4
Control Number 27-AS-20250701124404
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: 08/07/2025
NARRATIVE
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Allegation: There is no qualified administrator present at the facility. LPA conducted interview and record review as noted above. Based on evidence presented and interview conducted, it was revealed that Administrator of Record was temporarily out of the facility on leave, and staff1 (S1) has since assumed the role of management and administrative related duties. It was further revealed that although S1 has previously submitted documents to department of developmental services (DDS), S1 has not yet been approved by DDS to act as administrator of facility. Furthermore, no additional approved individual has been in place at the time this allegation was received by the Department. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

Allegation: Staff spoke inappropriately in front of client in care. LPA conducted interview and record review as noted above. Based on evidence presented, it was revealed that on 6-26-25, facility staff were observed speaking inappropriately while clients were present. Evidence revealed that such comments included foul language in “rude…sarcastic” tones. External report noted that during an occurrence in which an outside agency staff assisted with providing a snack to a client, a facility staff member used a “sarcastic” tone with foul language towards this agency staff while in the presence of the client. Additionally, it was revealed that an outside agency observed facility staff commenting inappropriately regarding R1 eating food directly off the table and quoted as saying: “like a seafood boil poured all over the table.” in a joking manner in front of the client. As a result of the above provided through evidence, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

Citations are issued as a result of this investigation 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)(1) within a 12-month period. An exit interview was conducted with licensee designees and a copy of this report was provided via email with request for return with signature. Appeal rights provided and LIC 811 provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20250701124404
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: 08/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2025
Section Cited
CCR
80076(a)(22)
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80076 Food Service (a) In facilities providing meals to clients, the following shall apply: (22)Tableware and tables, dishes, and utensils shall be provided in the quantity necessary to serve the clients. This requirement was not met as evidenced by:
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Licensee will ensure completed staff training on food safety and handling services. Training date to be submitted to LPA by POC due date. Proof of completed training to be submitted to LPA by 8-21-25.
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Based on observation and written evidence, facility staff provided food to client without a plate or utensils, resulting in client eating directly off the table. This posed a potential health and safety risk to client in care.
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Type B
08/21/2025
Section Cited
CCR
80063(a)(1)
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80063 Accountablity (a) The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation. (1) If the licensee is a corporation or an association, the governing body shall be active and functioning in order to ensure such accountability. This requirement was not met as evidenced by:
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Licensee to ensure an approved Administrator in place at facility by POC due date. Licensee to submit proof of approval to POC by due date.
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 Based on interview and record review, facility did not maintain an approved Administrator from DDS. This posed a potential health and safety 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: 08/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20250701124404
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: 08/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2025
Section Cited
CCR
80072(a)(1)
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80072 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 personal rights with emphasis on dignity and personal relations with clients. Proof of completed training to be submitted to LPA by POC due date.
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Based on observation and record review, facility staff engaged in inappropriate language and tone in the presence of clients in care. This posed a potential health, safety, and resident rights risk for 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: 08/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4