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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701177
Report Date: 11/08/2023
Date Signed: 11/08/2023 01:38:08 PM

Document Has Been Signed on 11/08/2023 01:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:TELECARE WHITE LANEFACILITY NUMBER:
392701177
ADMINISTRATOR:MONTEL JENNINGSFACILITY TYPE:
737
ADDRESS:1775 WHITE LANETELEPHONE:
(510) 621-9064
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY: 4CENSUS: DATE:
11/08/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Telecare Corporation, VMRC, DDSTIME COMPLETED:
11:00 AM
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On 11/8/23 at 10:00am the Department held a meeting to discuss the placement of Resident 1 (R1) who currently resides at Telecare White Lane. Present in the meeting were Acting Regional Manager Stephen Richardson, Licensing Program Manager (LPM) Liza King, LPM, Licensing Program Analyst (LPA) Michael Bilger, LPA Maja Jensen, Regional Director of Operations for Telecare Corporation, Christina Mance, Direct Care Supervisor for Telecare White Lane, Brandon Baty, VP of Operations with Telecare Corporation, Mary Thrower, Director of Special Services with Telecare Corporation, Holly Borso, Telecare Corporation Director of Community Services with Valley Mountain Regional Center (VMRC), Brian Bennett, Associate Director with VMRC, Lindsey Meninger, Division Manager - QA with VMRC, Katina Richison, QA with VMRC, Wanda Johnson, Assistant Deputy Director with the Department of Developmental Services (DDS), Catherine Knight, Behavior Specialist II with DDS, Greg Lee, and Safety Net Manager with the Office of Statewide Clinical Services, Angela Munoz.

The Department received a 3 day eviction notice for R1 on 10/31/23. LPA Michael Bilger requested supporting documentation to support the cause for eviction which was not received in its entirety. The Department was unable to review the request for approval for the 3 day eviction without supporting documentation and have provided TA related to issuing a 30 day notice. Christina Mance provided an update on R1's current situation and advised that R1 remains hospitalized.

Barriers to implementing the necessary supports were discussed including staffing, potential personal rights issues and community relations/acceptance. Alternate placement opportunities were discussed. Regional Center confirmed that options being explored include conducting a state wide search for higher and lower levels of care.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/08/2023
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Telecare Corporation has agreed to pursue a 30 day eviction which is currently being drafted and will be provided to the Department, Regional Center and DDS. Telecare Corporation will also be providing an organizational chart specific to Telecare Whitelane to Wanda Johnson so that she may pursue resource development approval. Community Care Licensing will review the 30 day evicition once received and continue to provide technical assistance as required for compliance with the California Code of Regulations and Health Safety Code.

This report was distributed electronically with request for signature.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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