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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 03:43:48 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
08/19/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250819124925
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:
01:10 PM
MET WITH:Amanda DuggiralaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to the clients
Staff did not properly report incidents involving a client
Staff did not ensure the facility grounds are properly secured
INVESTIGATION FINDINGS:
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On 9-3-2025 at 1:10pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegations noted above. LPA met with Administrator designee Amanda Duggirala and explained the purpose of the visit. During this investigation, LPA conducted interviews with two staff members, and reviewed incident reports submitted by facility. LPA also conducted a facility observation on 8-27-2025. LPA also reviewed photographs of facility property as part of this investigation.

Allegation: Staff did not provide adequate supervision to the clients. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, on 8-2-2025 at approximately 8:30pm, resident1 (R1) went to bed. Staff4 (S4) was in line of sight of R1's door. At approximately 8:45pm, S4 went on break with permission from lead staff (S3). A second staff member (S2) was completing chores elsewhere in the facility. At approximately 8:50pm, staff member walked past R1's room and observed door open wiith R1 not inside. S3 was alerted as well as all other staff on duty. Staff began to search for R1 who was located at a neighbor's yard fully disrobed at approximately 9:00pm.{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 4
Control Number 27-AS-20250819124925
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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Staff reported R1 was back inside facility by 9:10pm. Based on interview and record review, it was revealed that R1 was absent without supervision for approximately 15 minutes. It was further revealed through interview that R1 eloped due to inadequate supervision in that staff was given a break without adequate coverage to ensure R1's safety and whereabouts. No injuries resulted from this elopement event. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

Allegation: Staff did not properly report incidents involving a client. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, R1 eloped from facility on 8-2-2025. Incident was not reported as required immediately to Administrator or within 48 hours to regional center as required by their applicable laws and regulations. Incident was reported to Licensing department within regulatory time frames. Incident report submitted by facility regarding this incident stated: "The incident was not reported to administration or VMRC (regional center)." As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

Allegation: Staff did not ensure the facility grounds are properly secured. LPA conducted interviews, record reviews, and facility observation as noted above. Based on interviews and record reviews, it was revealed that on 8-2-2025, R1 eloped from facility and found in a neighbor's yard fully disrobed. It was further revealed that R1 was without supervision for approximately 15 minutes. On 8-27-2025, LPA observed multiple fenced boards down with neighbor's yard exposed and accessible on left side of facility's property. LPA observed unfilled pool located on neighbor's property. It was further observed that this area of the facility is accessible to residents in care. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

Citations are issued under Title 22, Division 6 and noted on LIC 9099D. An immediate civil penalty in the amount of $1000 is issued as a result of absence of supervision occurrence. An exit interview was held with lead staff Jill Lahman as administrator designee departed prior to the completion of this report, and gave permission for lead staff to sign in her absence. 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 4
Control Number 27-AS-20250819124925
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 A
09/04/2025
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 or designee will develop and submit a plan outlining appropriate supervision procedures ensuring resident whereabouts at all times.
Plan to be submitted to LPA by POC due date.
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Based on interviews and record reviews, R1 eloped from facility due to lack of appropriate supervision resulting in an absence of supervision. This posed an immediate health and safety risk to residents in care.
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Type A
09/04/2025
Section Cited
CCR
80087(a)
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80087 Building and Grounds. (a)The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidence by:
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Licensee or designee will ensure the immediate inaccessibility of fenced area by POC due date. Licensee or designee to send photo or video proof to LPA by POC due date.
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Based on observation, fenced area on left side of facility's property is missing multiple boards giving access to neighbor's yard containing an unfilled pool. Fenced area was accessible to residents in care.
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Licensee or designee to ensure repair or replacement of fenced area no later than 9/10/2025. licensee or designee will send photo proof to LPA by POC due date.
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 4
Control Number 27-AS-20250819124925
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
80064(a)(3)
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Administrator qualifications. (a) The administrator shall have the following qualifications: (3) Knowledge of and ability to comply with applicable law and regulation. This requirement was not met as evidence by:
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Licensee designee will submitted a signed declaration of understanding regarding regional center reporting requirements to LPA by POC due date.
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Based on interview and record review, R1 eloped from facility on 8-2-2024, and licensee did not ensure incident was reported to regional center per regional center reporting requirements. 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: 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: 4 of 4