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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700892
Report Date: 07/26/2023
Date Signed: 07/26/2023 03:10:53 PM

Document Has Been Signed on 07/26/2023 03:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 IFACILITY NUMBER:
502700892
ADMINISTRATOR:SANDHU, JEEVANJOATFACILITY TYPE:
735
ADDRESS:733 MONIQUE CTTELEPHONE:
(209) 531-6694
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 4CENSUS: 4DATE:
07/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lyric Marshall, House ManagerTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst(s) Renee Campbell and Victoria Brown arrived unannounced on 7/26/2023 at 3:00 pm. LPAs met with Lyric Marshall, House Manager and stated the purpose of the visit. LPAs are delivering findings from the Departments Financial Audit.

During the investigation, Community Care Licensing reviewed records and interviews that confirmed affected clients received their P&I monies intact, and timely. However, Community Care Licensing deemed that the facility failed to maintain adequate recordkeeping.

CCL obtained information that although the former staff was on shift when the P&I funds went missing and was dismissed from employment, this was deemed to not be at a level of financial abuse at this time.

In regard to procedures for safeguarding clients P&I funds, the Administrator stated that the facility handles cash resources for clients that are unable to manage their own cash. Facility maintains the client’s P&I locked in a secure area. Facility has a surety bond in place. Licensee shall review procedures and provide an in-service to staff based on the deficiency cited above.

Based on the information above, per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. An exit interview was conducted, and a copy of the report will be given.
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.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 07/26/2023 03:10 PM - It Cannot Be Edited


Created By: Renee Campbell On 07/26/2023 at 01:27 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
80026(h)(1)

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Safeguards for Cash Resources, Personal Property, and Valuables of Residents states: …maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to…current ledger accounting, with columns for income, disbursements and balance, for each client…Supporting receipts.
This requirement is not met as evidenced by:
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Licensee shall keep all receipts and a log for any resident monies obtained for the licensed facility for review by CCL upon request. A letter of agreement shall be submitted to CCL as well as an in-service for all staff regarding resident finance procedures. To be faxed by POC due date.
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Based on Licensee did not ensure residents records remained up to date regarding monies handled by facility.

This posed an 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.
SUPERVISOR'S 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


LIC809 (FAS) - (06/04)
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