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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700431
Report Date: 06/25/2025
Date Signed: 06/25/2025 02:41:45 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
01/10/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250110112718
FACILITY NAME:DELTA CARE FACILITIESFACILITY NUMBER:
502700431
ADMINISTRATOR:CATHERINE TORREZFACILITY TYPE:
735
ADDRESS:1604 COGNAC WAYTELEPHONE:
(209) 531-6694
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:4CENSUS: 4DATE:
06/25/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cristi Mamac, Caregiver TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Licensee not ensuring there is an administrator on the premises the number of hours necessary
Facility staff not assisting clients with grooming needs
INVESTIGATION FINDINGS:
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On 06/25/2025, Licensing Program Analyst arrived to the community unannounced to present findings for a complaint. LPA Campbell met with Cristi Mamac, Caregiver and explained the purpose of the visit.

Regarding the allegation that the licensee is not ensuring the administrator is on the premises for the hours necessary, of the five staff asked about the administrator’s presence, five (S7, S1, S6, S5 and S9) reported he is not. S7 stated that the administrator is there “3 to 4 hours a week and S1 reported “that “it is rare to see him there." According to S6, the administrator “is there 2 hours for the full week or maybe an hour in one day.” and per S5," We were supposed to have a meeting for questions about emergencies and he never came."

Regarding the allegation that staff are not assisting clients with grooming needs, LPA Campbell observed underwear with fecal stains. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiency is being cited on the attached 809-D during this visit. An exit interview was conducted, and copies of the report and appeal rights left.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
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 4
Control Number 27-AS-20250110112718
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: DELTA CARE FACILITIES
FACILITY NUMBER: 502700431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2025
Section Cited
CCR
85064(e)
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85064 (e) The administrator shall be on the premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation.

This requirement is not met as evidenced by:
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The administrator will present a statement of understanding regarding regulation 85064 and submit and maintain their work schedule with corrections for the next month by the POC due date.
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Based on interviews, the licensee was not present in the community the number of hours necessary to manage and administer the facility in compliance with law and regulation.
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Type B
07/11/2025
Section Cited
CCR
85077(b)
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85077 (b) Licensees shall provide basic laundry services, including washing and drying of clients' personal clothing.

This requirement is not met as evidenced by:
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The administrator will work with staff to provide a procedure through trial and error, to remove a majority of fecal stains from underwear by the POC due date .
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Based on observation, the licensee did not provide the basic services of clean laundry when underwear was found with fecal stains.
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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: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
01/10/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250110112718

FACILITY NAME:DELTA CARE FACILITIESFACILITY NUMBER:
502700431
ADMINISTRATOR:CATHERINE TORREZFACILITY TYPE:
735
ADDRESS:1604 COGNAC WAYTELEPHONE:
(209) 531-6694
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:4CENSUS: 4DATE:
06/25/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cristi Mamac, Caregiver TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Licensee not ensuring the required staff to client ratios are maintained
Lack of supervision resulting in client eloping
Licensee not ensuring unusual incidents are properly reported
Facility staff improperly restraining clients
Facility staff not ensuring clients receive quality meals
INVESTIGATION FINDINGS:
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Regarding the allegation that staff to client ratios are not being maintained, staff interviewed stated there was at least one staff on premises with residents as required (S6, S9, S7). Regulation 85065.5 states that if a client does not require staff to perform all activities of daily living, then the facility may maintain a ratio of 1 staff to 3 residents. Staff to client ratios are therefore being maintained as 1 to 2 residents are in day program during the week and the census is 4. When there are 4 residents present in the evening, additional staff are present per S1 who stated, sometimes “there are 4 staff for 4 clients.”

Regarding the allegation that there was a lack of supervision resulting in client eloping, S9 reported that they always follow clients who elope, staff stated that if they were alone, they called supervisors when following residents who elope. S6 stated that when the administrator was present and a client eloped, the administrator accompanied the resident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20250110112718
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: DELTA CARE FACILITIES
FACILITY NUMBER: 502700431
VISIT DATE: 06/25/2025
NARRATIVE
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Regarding the allegation that the licensee is not properly reporting unusual incident requests, S7 reported that only the administrator did the incident reports. S8 and S9 said that all staff had been trained on how to write incident reports, but LPA Campbell observed no incident reports that had been written by staff. LPA Campbell was able to confirm that incident reports had been received regarding client hitting staff on 04/10/25, and self-injurious behavior on 04/28/2025.

Regarding the allegation that facility staff improperly restrain clients, S7 and S9 report not restraining clients and that they are aware that staff are not allowed to restrain clients. S1 recounted being guided by the administrator in redirecting a client physically when they attacked staff. No restraints were involved.

Regarding allegation that staff are not ensuring clients receive quality meals, S9 stated “we feed them good. I get jealous. “ S1 recounted a variety of meals from March and S7 reported that menus may change due to not having a specific ingredients so meal items will be substituted if they are missing and S5 acknowledged that there are some clients who are just “picky eaters who only want meat and toast.”

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore these allegations are UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies are cited. Exit interview was held and a copy of report was given to Cristi Mamac, Caregiver.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4