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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700431
Report Date: 10/07/2021
Date Signed: 11/16/2021 03:29:33 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2021 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20210210123824
FACILITY NAME:DELTA CARE FACILITIESFACILITY NUMBER:
502700431
ADMINISTRATOR:SANDHU, JEEVANJOATFACILITY TYPE:
735
ADDRESS:1604 COGNAC WAYTELEPHONE:
(209) 531-6694
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:4CENSUS: 4DATE:
10/07/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jeevanjoat SandhuTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not properly trained

Clients are not being provided proper care and supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Unannounced complaint visit made out to this facility on 10/07/2021 and was met by the facility caregiver, Taswardeep Kaur, who was requested by LPA Charlie Yang to go ahead and contact the facility designated Administrator, Jeevanjoat Sandhu, to inform him that CCL was present at this time. Facility designated Administrator Jeevanjoat Sandhu arrived later to this facility. Current census was 4 residents.
Based on a review of the facility documents it was observed that facility personnel were given monthly online training as well as annual training. In addition, facility documents revealed that facility personnel were trained and certified as DSP I, Direct Support Professionals, since being employed at this facility. Medication training is given to all facility personnel since they are able to handle, dispense, and document all resident medications while on duty. A review of the facility LIC 500 revealed that there was sufficient staff coverage during regular business hours extending into the PM and NOC shifts as well. Staff coverage was also documented for weekend days and hours.
As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time. Exit Interview

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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