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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507004968
Report Date: 04/15/2026
Date Signed: 04/15/2026 12:21:19 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
01/12/2026 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260112111442
FACILITY NAME:DELTA STAR HOME CARE 2FACILITY NUMBER:
507004968
ADMINISTRATOR:OSUKA, FESTUS JOHNFACILITY TYPE:
735
ADDRESS:2600 PINOT LANETELEPHONE:
(209) 408-8447
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:6CENSUS: 6DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nessy Abella TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff do not distribute residents' medications as prescribed


INVESTIGATION FINDINGS:
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On 04/15/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings for the allegations above. LPA Pascua met with Facility Designated Administrator (FDA), John Osuka and Facility Designated Representative (FDR), Nessy Abella and explained the purpose of the visit. Current census was 6. 3 out 6 residents were out at their respective day programs at this time.
It was alleged that staff do not distribute residents medications as prescribed. Based on information obtained from the regional center it was observed that R1s prescribed medications remaining in the bubble packs were not administered from from 1/3/2026 through 1/9/2026, however the Medication Administration Record indicated that these medications were medications were administered to R1 at that time. Based on the information gathered, staff do not distribute residents medications as prescribed.
As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.
The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Exit Interview
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
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 5
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
01/12/2026 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260112111442

FACILITY NAME:DELTA STAR HOME CARE 2FACILITY NUMBER:
507004968
ADMINISTRATOR:OSUKA, FESTUS JOHNFACILITY TYPE:
735
ADDRESS:2600 PINOT LANETELEPHONE:
(209) 408-8447
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:6CENSUS: 6DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nessy AbellaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff yells at residents
Staff hits resident
Staff confines residents to bedrooms and couch
Staff do not maintain exits free from obstruction
Staff uses an unusual form of punishment for residents
Staff did not ensure that medication was stored locked and inaccessible to residents in care
Staff do not ensure that residents' dietary needs are met
Staff do not maintain a comfortable temperature at facility for residents in care
Staff mismanage residents' resources
INVESTIGATION FINDINGS:
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On 04/15/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings for the allegations above. LPA Pascua met with Facility Designated Administrator (FDA), John Osuka and Facility Designated Representative (FDR), Nessy Abella and explained the purpose of the visit. Current census was 6. 3 out 6 residents were out at their respective day programs at this time.
Allegation: Staff yell at residents
It was alleged that staff yell at residents. During the course of this investigation, the department conducted interviews. Based on interviews conducted with 4 staff members. 4 out 4 staff members deny that they yell at the residents or have seen anyone yell at residents in care. An interview with 6 residents were conducted. 6 out 6 residents denied that the staff yell at them or have witnessed any staff member yell at other residents. Based on this information gathered, there is not sufficient evidence to prove that the staff yell at residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20260112111442
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 STAR HOME CARE 2
FACILITY NUMBER: 507004968
VISIT DATE: 04/15/2026
NARRATIVE
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Allegation: Staff hits residents
It was alleged that staff hit residents. During the course of this investigation, the department conducted interviews. Based on interviews conducted with 4 staff members. 4 out 4 staff members deny that they hit the residents or have seen anyone hit residents in care. An interview with 6 residents were conducted. 6 out 6 residents denied that the staff hit them or have witnessed any staff member hit other residents. Based on this information gathered, there is not sufficient evidence to prove that the staff hit residents.

Allegation: Staff confines residents to bedrooms and couch
It was alleged staff confines residents to bedrooms. During the course of this investigation, the department conducted interview. An interview with 4 staff were conducted. 4 out 4 staff members deny that they confine residents to bedrooms and the couch. It was stated by 4 staff members that residents are able to leave their room at any time. An interview with 6 residents were conducted, 6 out 6 residents denied that they were unable to leave their bedrooms. Based on the information gathered, there is not sufficient evidence to prove that staff confines residents to bedrooms.

Allegation: Staff do not maintain exits free from obstruction
It was alleged that staff do not maintain exits free from obstruction. During the course of this investigation, the department conducted a tour of the facility on 1/21/2026 and 04/15/2026 and observed that there are no obstructions to the facility exits. Based on the information gathered, there is not sufficient evidence to prove that staff do not maintain exits free from obstruction.

Allegation: Staff uses an unusual form of punishment for residents
It was alleged that staff uses an unusual form of punishment for residents. During the course of this investigation, the department conducted interviews. An interview with 4 staff were conducted. 4 out 4 staff members deny that they use an unusual form of punishment for residents. 4 out 4 staff members state that the facility staff use de-escalation techniques to assist residents in care. An interview with 6 residents were conducted. 6 out 6 residents state that they are happy at the facility and do not feel that they are being punished. Based on the information gathered, there is not sufficient evidence to prove that staff use an unusual form of punishment for residents.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20260112111442
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 STAR HOME CARE 2
FACILITY NUMBER: 507004968
VISIT DATE: 04/15/2026
NARRATIVE
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Allegation: Staff did not ensure that medication was stored locked and inaccessible to residents in care
It was alleged that staff did ensure that the medication was stored locked and inaccessible to residents in care. During the course of this investigation, 4 out 4 staff members deny that medication is not locked and made inaccessible to residents in care. The department verified that medication was locked and made inaccessible on visits conducted on 1/21/2026 and 04/15/2026. Based on the information gathered, there is not sufficient information to prove that staff did not ensure that medication was stored locked and inaccessible to residents in care.

Allegation: Staff do not ensure that residents' dietary needs are met
It was alleged that staff do not ensure that resident's dietary needs are met. During the course of this investigation, the department conducted interviews and reviewed facility records. An interview with 4 staff members were conducted. 4 out 4 staff members deny that they do not meet residents dietary needs. 4 out 4 staff members state that there are no dietary restrictions. An interview with 6 residents were conducted. 6 out 6 residents state that there they enjoy the food provided to the facility and have snacks throughout the day. A tour of the facility food supply was conducted. LPA Pascua observed a sufficient amount of food supply to meet the residents needs. Based on the information gathered, there is not sufficient information to prove that staff did not ensure that residents dietary needs are met.

Allegation: Staff do not maintain a comfortable temperature at facility for residents in care
It was alleged that staff do not maintain a comfortable temperature at facility for residents in care. An interview with 6 residents were conducted. 6 out 6 residents state that the facility is comfortable. LPA Pascua verified the facility temperature during a visit on 04/15/2026 which was at 70 degrees. Based on gathered, there is not sufficient information to state that staff did not maintain a comfortable temperature at the facility.

Allegation: Staff mismanage residents' resources
It was alleged that staff mismanage residents' resources. It was denied by 6 residents that they are able to manage all their resources and belongings.
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
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20260112111442
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 STAR HOME CARE 2
FACILITY NUMBER: 507004968
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2026
Section Cited
CCR
80075(b)
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(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.
This is not met as evidenced by: Based on medication review and interviews, The licensee did not ensure that the facility ensure that medication was provided as prescribed. It
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Facility Administrator stated that a review of the section will be conducted. A statement of correction, along with proof of staff training from an outside vendor for no less than (1) hour in duration,
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This poses a potential health safety and personal rights risks to persons in care.
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for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date. Information submitted must include attendees, trainers, and information discussed.
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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: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5