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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701177
Report Date: 12/05/2025
Date Signed: 12/05/2025 03:17:06 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
11/17/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20251117154044
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:
12/05/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Danica MorrisonTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff mishandled resident's medication
INVESTIGATION FINDINGS:
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On 12-5-2025 at 1:50pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with program administrator Danica Morrison and explained the purpose of the visit. During this investigation, LPA conducted interviews with three staff members and reviewed medication records pertaining to resident1 (R1).

Allegation: Facility staff mishandled resident's medication. Based on interview and record reviews, it was revealed that on or about 11-11-2025, facility staff prepared medication to be given to R1's responsible person for R1's home outing. It was further revealed that two tablets of medication Hydrochlorothiazide were given to R1's responsible party prior to commencement of home visit with instructions for 1 tablet by mouth daily. Interviews further revealed a request for additional medication as the length of the home visit was undetermined at the time of departure. Additional interviews revealed corroborated statements that facility's normal practice in regards to home visits is to give all available medication upon commencement of the home visit to ensure a ready supply in the event of an extended stay. {Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2025
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 3
Control Number 27-AS-20251117154044
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: 12/05/2025
NARRATIVE
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The investigation found that during R1's home visit, R1 did not have the proper amount of medication available as a result of the amount of medication provided. It was further revealed within corroborated statements that staff member who prepared medication performed a wrongful act resulting in an inappropriate amount of medication given to R1's responsible person.

As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. A civil penalty in the amount of $250 is issued in addition to citation due to repeat violation of Section 80075(b) within a 12-month period. An exit interview was conducted with program administrator 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: 12/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20251117154044
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: 12/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/08/2025
Section Cited
CCR
80075(b)
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80075 Health Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement was not met as evidenced by:
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Licensee to ensure staff training on medication handling with emphasis on procedural methods regarding medication preparation for resident home visits. Training date to be submitted to LPA by POC due date with proof of completed training to be sent to LPA no later than 12-22-2025.
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Based on interview and record review, Licensee did not ensure compliance with above regulation in that a staff member did not properly prepare medication upon R1's home visit. This posed an immediate health and safety 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: 12/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3