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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700431
Report Date: 07/26/2023
Date Signed: 07/26/2023 03:33:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
12/09/2022 and conducted by Evaluator Renee Campbell
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20221209121041
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:
07/26/2023
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Lyric Marshall, House ManagerTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility failed to report timely
INVESTIGATION FINDINGS:
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THIS REPORT IS AMENDING THE FINDING FROM UNSUBSTANTIATED TO SUBSTANTIATED. AND A NEW 9099 NOW SUPERSEDES IT.
Licensing Program Analyst(s) Renee Campbell and Victoria Brown arrived unannounced to amend the complaint findings on 7/26/2023 at 3:15 pm. LPAs met with Lyric Marshall, House Manager and stated the purpose of the visit. Lyric Marshall, House Manager contacted the licensee regarding today's visit. Upon further review of interviews, documentation, and Financial Audit, LPA found that the Administrator admitted funds were missing in the amount of approximately $50. When the administrator discovered that resident(s) funds were missing and replaced the amounts with personal/facility funds. The administrator stated that he contacted Community Care Licensing (CCL) by phone regarding the issue but did not submit an incident report.
Based on confirmation of the Administrator that this did not occur, the above allegation(s) is found to be SUBSTANTIATED.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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 3
Control Number 27-AS-20221209121041
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: DELTA CARE FACILITIES
FACILITY NUMBER: 502700431
VISIT DATE: 07/26/2023
NARRATIVE
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A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiencies are being cited on the attached 9099D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. Appeal rights were provided. An exit interview was conducted, and a copy of the report was provided.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20221209121041
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: DELTA CARE FACILITIES
FACILITY NUMBER: 502700431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
80061(b)(1)(E)
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80061(b)(1)(E) Upon the occurrence, during the operation of the facility, of any of the events...a report shall be made to the licensing agency within the agency's next working day...a written report...shall be submitted to the licensing agency within seven days following the occurrence of such event. Any unusual incident or client absence which threatens the physical or emotional health or safety of any client. Events reported shall include the following: Any unusual incident or client absence which threatens the physical or emotional health or safety of any client.
This requirement is not met as evidenced by
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Licensee/Administrator shall submit in writing that all reporting requirements will be followed at all times. Fax POC by stated due date.
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Based on Confirmation from Administrator only a shared information report was submitted to RC. He failed to submit an SIR to CCL and RC timely. This poses a potential health and safety risk to residents in care.
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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: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3