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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700892
Report Date: 04/07/2023
Date Signed: 04/07/2023 03:04:19 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-20221209095052
FACILITY NAME:DELTA CARE FACILITIES IFACILITY NUMBER:
502700892
ADMINISTRATOR:SANDHU, JEEVANJOATFACILITY TYPE:
735
ADDRESS:733 MONIQUE CTTELEPHONE:
(209) 531-6694
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:4CENSUS: 4DATE:
04/07/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jeevanjoat Sandhu, AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Missing P&I Funds
INVESTIGATION FINDINGS:
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On 03/01/2023, Licensing Program Analyst Renee Campbell arrived unannounced to deliver findings for the complaint allegation noted above. LPA met with the Administrator and explained the purpose of the visit.
Over the course of the investigation, LPA Campbell reviewed documentation regarding the missing funds. The Administrator reported that funds were missing in the amount of $20 and then $30. The Administrator replaced the funds immediately but could not immediately account for the funds.
The Department determines the licensee was out of compliance with Title 22 regulations 87217, Safeguards for Resident Cash, Personal Property, and Valuables and was therefore unable to account for the funds when they were taken because procedures were not followed correctly.

The department has concluded the investigation and the preponderance of evidence standard has been met and therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was conducted via phone and the report was emailed return receipt requested.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
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 2
Control Number 27-AS-20221209095052
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 I
FACILITY NUMBER: 502700892
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2023
Section Cited
CCR
80026(h)(1)
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80026 Safeguards for Resident Cash, Personal Property, and Valuables (h)(1) Each licensee shall maintain accurate records of accounts of cash resources…

This requirement was not met as evidenced by:
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Licensee will review procedures for handeling client funds during shift changeover and provide a written procedure report signed by staff by POC due date.
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Based on observation, interviews and/or record review, Licensee did not audit client account activity accurately which poses an potential Health, Safety or Personal Rights risk to persons 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: 04/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2