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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803851
Report Date: 12/15/2021
Date Signed: 12/15/2021 11:08:12 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/18/2021 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 21-AS-20211018131220
FACILITY NAME:TELECARE BECK LANEFACILITY NUMBER:
486803851
ADMINISTRATOR:MONTEL JENNINGSFACILITY TYPE:
738
ADDRESS:4500 BECK LANETELEPHONE:
(707) 880-3254
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:4CENSUS: 3DATE:
12/15/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Montel JenningsTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
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7
8
9
Resident needs a higher level of care.
Facility is out of ratio.
INVESTIGATION FINDINGS:
1
2
3
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5
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9
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13
Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Telecare Beck Lane for the purpose of delivering complaint findings. LPA was greeted at the door by Administrator, Montel Jennings and was granted access into the facility.

During the course of the investigation, LPA interviewed staff, various outside parties, reviewed staff, client and facility records.

Complaint alleges that resident needs a higher level of care. Based on LPA observation of resident records, facility records and confidential interviews that were conducted, LPA learned that the placement for Client #1 is appropriate for the needs of the client.

(Report continued on LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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 2
Control Number 21-AS-20211018131220
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: TELECARE BECK LANE
FACILITY NUMBER: 486803851
VISIT DATE: 12/15/2021
NARRATIVE
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Complaint alleges that the facility is out of ratio. Based on record review and interviews, LPA learned that the staff Roster appeared to be appropriate at the time of the review and that the client to staff ratio appears to be appropriate for the clients in care. During an unannounced subsequent complaint investigation inspection dated for November 2, 2021, LPA observed appropriate client to staff ratio. In addition, LPA observed six staff members and three clients in care at the time of the subsequent complaint investigation inspection.

Based on the interviews that were conducted, the observation of the facility and the documents/evidence reviewed, the allegations of, resident needs a higher level of care and the facility is out of ratio will be Unsubstantiated. A finding that the complaint allegations are unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted and a copy of this report was signed and given to the Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2