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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701177
Report Date: 09/03/2025
Date Signed: 09/03/2025 11:50:16 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
06/13/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250613103118
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:
09/03/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Amanda DuggiralaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff made inappropriate comments towards client
INVESTIGATION FINDINGS:
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On 9-3-2025 at 10:45am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with Administrator designee Amanda Duggirala and explained the purpose of the visit. During the course of this investigation, LPA conducted interviews with six staff members, and one additional witness. LPA also reviewed documentation including behavior support care plan, incident report, physician notes, and individual program plan (IPP) all pertaining to resident (R1). Additionally, LPA conducted a facility observation on 7-7-2025.

Allegation: Staff made inappropriate comments towards client. LPA conducted interviews and record reviews as noted above. A review of incident report dated 4-20-2025 reveals that a staff member described R1 has “whining” while describing an incident which occurred that day and referencing R1’s known signs of his anxiety level. Based on this review, the preponderance of evidence standard is met, and 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: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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 6
Control Number 27-AS-20250613103118
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: 09/03/2025
NARRATIVE
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Citation is issued under Title 22, Division 6 and noted on LIC 9099D. An additional civil penalty 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 Administrator designee and a copy of this report was provided. LIC 811 and appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20250613103118
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: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2025
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 will ensure completed staff training on resident rights with special emphasis on inappropriate language and both written and verbal regarding describing residents in care. Proof of completed staff training to be sent to LPA by POC due date.
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Based on record review, staff utilized inappropriate labeling of a resident based on behavior episodes. This posed a potential health, safety, and resident rights risk to resident 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: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
06/13/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250613103118

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:
09/03/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Amanda DuggiralaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff are not ensuring timely medical attention for resident
Staff are not meeting clients care plan needs
Staff are overmedicating client
Client sustained pressure injury due to staff neglect
Staff are not providing adequate food service to client resulting in client losing weight
Staff are not allowing client to have phone calls
INVESTIGATION FINDINGS:
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On 9-3-2025 at 10:45am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegations noted above. LPA met with Administrator designee and explained the purpose of the visit. During the course of this investigation, LPA conducted interviews with six staff members, and one additional witness. LPA also reviewed documentation including medication log sheets, behavior support care plan, facility menu, incident report, physician notes, individual program plan (IPP), and other medical related documents all pertaining to resident1 (R1). Additionally, LPA conducted a facility observation on 7-7-2025.
Allegation: Staff are not ensuring timely medical attention for resident. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that R1 had multiple visits to emergency rooms (ER) due to various condition such as injuries due to behaviors and restraints used through staff intervention. Additionally, it was revealed that R1 had previously developed other injuries due to falls and a stage one healing pressure injury. {Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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 6
Control Number 27-AS-20250613103118
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: 09/03/2025
NARRATIVE
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Documentation review and interview revealed that staff utilized treatment options for wounds and have arranged for ER visits when appropriate. It was further revealed that facility’s nursing staff has provided intervention as appropriate, and R1 has utilized outside medical services as well. Interviews conducted did not reveal any corroborated statement of R1 not receiving appropriate and timely medical attention. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Allegation: Staff are overmedicating client. LPA conducted interviews and record reviews as noted above. Based on review of medication log sheets and associated physician orders, and interviews conducted, it was determined that facility staff have followed physician orders regarding medication. Interviews and record reviews did not reveal any corroborated evidence of staff over utilizing medication resulting in the overmedicating of client in care. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Allegation: Client sustained pressure injury due to staff neglect. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that R1 sustained a stage one pressure injury as diagnosed on or about 6-19-25. Medication log sheets and interviews conducted further revealed that staff were aware of the pressure injury and have utilized medication to the affected area(s). Interviews further revealed that R1 is active for most times during the day resulting in a high risk for falls and supervised by staff as appropriate during these times. Additionally, the investigation did not reveal any further corroborated evidence that such injury was caused by a direct result of staff neglect. The preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Allegation: Staff are not providing adequate food service to client resulting in client losing weight. LPA conducted interview, facility observation, and record reviews as noted above. Based on review of facility’ menu and observation of facility, It was revealed that facility is providing and making available the adequate nutritional needs for R1 and other clients in care. Interviews conducted in regard to weight loss revealed that R1 prefers and consumes various other food choices. Interviews further revealed that R1 does consume food provided by facility throughout the course of a day and is encouraged by staff to consume the nutrition regimen and hydration products as recommended and planned by nutritionist. Although R1 has a noted weight loss on record, the investigation did not reveal any corroborated or direct evidence to suggest staff are not providing adequate food service as to cause such weight loss. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. {Cont on 9099C}
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20250613103118
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: 09/03/2025
NARRATIVE
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Allegation: Staff are not allowing client to have phone calls. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that during various behavioral episodes involving R1, R1’s responsible person has been notified by staff via phone who attempts to give R1 the opportunity to speak with responsible person. Additionally, based on interviews, there were no corroborated statements of R1 not being allowed to have phone calls for other purposes. As a result, there is not a preponderance of evidence to conclude staff are not allowing client to have phone calls, therefore, this allegation is UNSUBSTANTIATED.

Allegation: Staff are not meeting clients care plan needs. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews it was revealed that R1 currently has a supervision plan of care in place for 3:1 staffing ratio. It was further revealed that on 6-12-2025 during a behavioral episode, R1 was required to have a 2:1 staffing ratio which was utilized at that time. Additional interviews and record reviews also revealed that various restraint methods and notification to law enforcement have been used after verbal prompts and other interventions noted in R1’s care plan were attempted. Additional methods used by law enforcement are not part of R1’s care plan for facility to follow. Investigation did not reveal additional corroborated evidence of staff not meeting clients care plan needs, therefore 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 Administrator designee and a copy of this report was provided. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6