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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701177
Report Date: 12/17/2025
Date Signed: 12/17/2025 03:24:05 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
11/09/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20251109183815
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: 1DATE:
12/17/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Danica MorrisonTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff did not ensure to follow resident's doctor's care plan
Staff does not properly document resident's change in medical conditions
INVESTIGATION FINDINGS:
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On 12-17-2025 at 10:45am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation and deliver findings for the allegations noted above. LPA met with program administrator Danica Morrison and explained the purpose of the visit. During this investigation, LPA conducted interview with staff1 (S1) and reviewed facility file documentation including medication orders for resident1 (R1), medication log sheets for R1,various email communications and care notes pertaining to R1

Allegation: Staff did not ensure to follow resident's doctor care plan. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that on 5-7-2025, a medical visit for R1 resulted in a message from the attending medical professional stating "suture removal, apply Vaseline BID X3 weeks to posterior neck." A review of medication log sheets and care notes did not reveal a follow up for the ointment usage. An email communication written on 5-24-2025 states that R1's neck was red and that ointment application had not been applied unless R1's neck appeared itchy {Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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-20251109183815
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: 12/17/2025
NARRATIVE
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LPA did not observe or received additional evidence to indicate the above procedure was performed. As a result of this investigation, it is determined that a plan written and signed by a medical professional was not followed. 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.

Allegation: Staff does not properly document resident's change in medical conditions. LPA conducted interview and record review as noted above. The allegation refers to various rashes noted on R1 and lack of documentation pertaining to such. A review of previous documentation including body check forms for R1 was conducted as part of an investigation for complaint #27-AS-20250827115412 which alleged staff did not properly observe rashes as change of condition. This investigation determined that a lack of documentation occurred as part of the observation process and the allegation was substantiated. The above current allegation refers to the same or similar event regarding R1 within that time period, therefore this allegation is SUBSTANTIATED. As licensee was previously cited for this allegation as noted in complaint #27-AS-20250827115412 on 11-7-2025, no citation is issued at this time for the above current allegation.

An exit interview was conducted with program administrator and a copy of this report was provided. A civil penalty in the amount of $250 is issued in addition to citation due to repeat violation of Section 80078(a) within a 12-month period. Appeal rights provided.






SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20251109183815
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: 12/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2025
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 will develop a plan ensuring staff follow up on medical professionals' plans of care for residents. Plan to be submitted to LPA by POC due date.
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Based on interview and record review, staff did not apply a specific treatement necessary for R1's needs as written by a medical professional during a medical visit. This posed a potential health and safety risk for 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: 12/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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
11/09/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20251109183815

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: 1DATE:
12/17/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Danica MorrisonTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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2
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9
Staff does not communicate with resident's responsible party of change in medical conditions
INVESTIGATION FINDINGS:
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On 12-17-2025 at 10:45am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation and deliver findings for the allegations noted above. LPA met with program administrator Danica Morrison and explained the purpose of the visit. During this investigation, LPA conducted interview with staff1 (S1) and reviewed facility file documentation including medication orders for resident1 (R1), medication log sheets for R1, incident reports, various email communications and care notes pertaining to R1.

Allegation: Staff does not communicate with resident's responsible party of change in medical conditions. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews it was determined that various forms of communication were utilized in communication with responsible party including emails and incident reports. The allegation above references injuries to R1 including head and toe abrasions. A review of incident reports dated 5-4-2025 describe similar injuries along with notation of informing responsible party. {Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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-20251109183815
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: 12/17/2025
NARRATIVE
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Additional review of incident reports and care notes reveal additional consistent communication with responsible party regarding R1's various conditions. As a result, there is not a preponderance of evidence to conclude facility staff is not consistently communicating with R1's responsible party in regards to R1's changes in condition. As a result, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with program 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: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5