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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701177
Report Date: 10/28/2025
Date Signed: 10/28/2025 03:12:20 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
09/10/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250910194127
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: 2DATE:
10/28/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Danica MorrisonTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff did not take proper protocols to intervene an altercation between a resident and staff.
INVESTIGATION FINDINGS:
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On 10-28-2025 at 1:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with Administrator Danica Morrison and explained the purpose of the visit. During this investigation, LPA conducted interviews with seven staff members and reviewed facility file documentation including individual behavior support plan (IBSP), and individual program plan (IPP) pertaining to resident1 (R1). Additionally, LPA reviewed incident report referencing an incident which occurred on or about 9-5-2025, and hospital discharge paperwork.
Allegation: Staff did not take proper protocols to intervene an altercation between a resident and staff. The complainant alleged specifically that on 9-5-2025, staff did not use proper protocols and safety measures which resulted in a resident and staff altercation, and injuries to both parties involved. Based on interviews and record reviews, it was revealed that on or about 9-5-2025, R1 engaged in a behavior which involved throwing personal objects within his room and self injurious behavior, as well as disrobing and injury to a staff member. {Cont on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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-20250910194127
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: 10/28/2025
NARRATIVE
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On the above date, R1 was attempting to call a family member without success and became angry which resulted in R1 throwing his phone across the room. Two staff members approached the door. Staff members attempted verbal de-escalations. One staff member entered R1’s room to retrieve the phone and speak with R1. Based on interviews, R1 immediately pushed staff member against the wall, hit staff member, and began engaging in self-injurious behaviors and disrobing. Staff members separated to avoid further injury and incidents, however, R1 made additional contact with staff member and began choking her. Staff members on duty assisted in successfully removing R1’s hands from this staff member’s throat area. Interviews conducted with staff members revealed corroborated statements that staff member entered R1’s room alone and during an observed behavior which should not have occurred given the particulars as noted above and contributed to R1’s escalated behaviors. It was further determined through interviews that during the behavior episode of R1, an additional staff member was on duty and not actively engaging in attempts to intervene during the event. After the event, this staff member arrived with protective pads, however, R1’s behaviors had subsided. This event resulted in minor injuries to R1 as well as staff member involved. Additionally, it was determined through interviews that staff members have been trained on appropriate interventions regarding resident behaviors, as well as how and when to engage. As a result, it is determined that staff did not ensure proper protocols and safety measures which contributed to R1’s escalated behaviors and altercation with another staff.

As a result, the preponderance of evidence standard is met, and 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 a repeat violation of Section 80078(a) within a 12-month period. An exit interview was conducted with Administrator 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: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20250910194127
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: 10/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/29/2025
Section Cited
CCR
80078(a)
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80078(a) 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 develop and submit a plan outlining safety protocol during a behavior intervention. Plan to be submitted to LPA by POC due date.
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Based on interview and record review, licensee did not ensure appropriateness of care and supervision in that staff did not utilize adequate safety measures and other protocols during R1’s behavior event. This posed an immediate health and safety risk to resident in care.
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Licensee to ensure completed staff re-training and training of any updates to safety protocols regarding behavior interventions. Training date to be submitted to LPA by POC due date, and proof of completed staff training to be sent to LPA not later than 11/12/2025.
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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: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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
09/10/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250910194127

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: 2DATE:
10/28/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Danica MorrisonTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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2
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Staff did not notify resident's responsible party of incident.
INVESTIGATION FINDINGS:
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On 10-28-2025 at 1:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with Administrator Danica Morrison and explained the purpose of the visit. During this investigation, LPA conducted interviews with seven staff members and reviewed facility file documentation including individual behavior support plan (IBSP), and individual program plan (IPP) pertaining to resident1 (R1). Additionally, LPA reviewed incident report referencing an incident which occurred on or about 9-5-2025.
Allegation: Staff did not notify resident’s responsible party of incident. Based on interviews and records reviews as noted above, it was determined that on or about 9-5-2025, R1 engaged in escalated behaviors including self-injurious behavior, disrobing, and altercation with staff member. Based on review of incident report, it was determined that licensee ensured timely reporting of incident to responsible party and the Department per regulations. {Cont.on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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-20250910194127
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: 10/28/2025
NARRATIVE
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Additionally, it was determined that although staff have been unable to meet with responsible party regarding additional issues, attempts have been made to do so. As a result, there is not a preponderance of evidence to conclude staff are not notifying responsible party of incidents, 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 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: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5