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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803851
Report Date: 01/06/2022
Date Signed: 01/06/2022 06:03:19 PM

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
04/13/2021 and conducted by Evaluator Katrina Walters
COMPLAINT CONTROL NUMBER: 21-AS-20210413170815

FACILITY NAME:TELECARE BECK LANEFACILITY NUMBER:
486803851
ADMINISTRATOR:PONCE,MELISSAFACILITY TYPE:
738
ADDRESS:4500 BECK LANETELEPHONE:
(707) 880-3254
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:4CENSUS: DATE:
01/06/2022
UNANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Montel JenningsTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff violated clients rights hitting and threatening client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Walters arrived unannounced to deliver findings for the above allegations 21-AS-20210413170815. LPA was greeted by Lead Staff, Rosa Paxton.

The Department received a complaint alleging the following: that Staff violated client’s rights hitting and threatening client. During the investigation LPA reviewed resident, staff, and facility records, gathered various supporting documents, such as disciplinary actions, trainings, incident reports, and conducted interviews with staff and other outside parties. The allegations occurred while the facility was under supervision of former Administrator Melissa Ponce. There was conflicting information obtained from staff. Based on the records reviewed and interviews conducted there is insufficient evidence to prove or disprove the allegations above occurred.
Continued on 9099 C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20210413170815
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: 01/06/2022
NARRATIVE
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Therefore the allegations that Staff violated clients rights hitting and threatening client are UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies cited during today’s visit.
Exit interviews were conducted.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3