392701177-10-7-2025-27-AS-LKIG-DMHV3U-20251016160518

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701177
Report Date: 10/07/2025
Date Signed: 10/07/2025 12:44:10 PM

Unsubstantiated

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
08/25/2025 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20250825065134

FACILITY NAME:	TELECARE WHITE LANE		FACILITY NUMBER:	392701177
ADMINISTRATOR:	DANICA MORRISON		FACILITY TYPE:	737
ADDRESS:	1775 WHITE LANE		TELEPHONE:	(510) 621-9064
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95215
CAPACITY:	4	CENSUS: 2	DATE:	10/07/2025
		UNANNOUNCED	TIME BEGAN:	11:22 AM
MET WITH:	Danica Morrison		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff caused injury to a resident in care.
Staff inappropriately restrained a resident in care.

INVESTIGATION FINDINGS:

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On 10-7-2025 at 11:22am, Licensing Program Analysts (LPAs) Michael Bilger and Sommer Hayes arrived unannounced to deliver findings for the allegations noted above. LPA met with Administrator Danica Morrison and explained the purpose of the visit. During this investigation, LPA conducted interviews with three staff members including a former staff member. Addiitonally, LPA reviewed facility file documentation including behavior care plans for resident1 (R1), and an incident report dated 8-3-2025.
Allegation: Staff caused injury to a resident in care. LPA conducted interviews and record reviews as noted above. Based on these interviews and record reviews, it was determined that on or about 8-3-2025, R1 engaged in behavior which included self-injurious behavior, attempts to hit staff, and attempts to leave the facility in an unsafe manner. It was further revealed that staff on duty attempted verbal redirection which were unsuccessful resulting in a “turn away” procedure which was also unsuccessful. As a result, a “high standing hold” was placed on R1 for approximately 1 minute.
{Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250825065134

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: 10/07/2025

NARRATIVE

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During this hold a fingernail from a staff member made contact with R1 leaving a scratch. Hold was released once R1 displayed signs of tension reduction. Interviews conducted resulted in corroborated statements of appropriate procedures followed, with no intention of injuring R1 during the process of restraint. As result, there is not a preponderance of evidence to prove staff cause an injury to a resident in care intentionally or through inappropriate care and supervision procedures, therefore, this allegation is UNSUBSTANTIATED.

Allegation: Staff restrained a resident in care. LPA conducted interviews and record reviews as noted above. Based on these interviews and record reviews, it was determined that on or about 8-3-2025, R1 engaged in behavior which led to use of a “high standing hold.” Interviews conducted revealed that this hold was placed on R1 due to R1 attempting to elope in an unsafe manner and a threat to his physical health. Record reviews indicate various interventions including verbal de-escalations, and use of restraints may be used as necessary based on behavior to prevent R1 from harming self and others. Although a restraint was used on R1 by staff, there is no corroborating evidence resulting from this investigation to suggest a violation occurred as a result of using the restraint. 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 Administrator and a copy of this report was provided. Appeal rights provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

LIC9099 (FAS) - (06/04)

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