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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507004969
Report Date: 04/15/2026
Date Signed: 04/15/2026 11:03:55 AM

Unsubstantiated


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-20260112085556
FACILITY NAME:DELTA STAR HOME CAREFACILITY NUMBER:
507004969
ADMINISTRATOR:OSUKA, ADA P.FACILITY TYPE:
735
ADDRESS:2113 QUEBEC COURTTELEPHONE:
(209) 572-3711
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:6CENSUS: 6DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Nessy Abella TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff yell at residents
Staff do not ensure that residents' dietary needs are met
Staff confines residents to bedrooms
Staff do not follow infection control protocol
Staff do not maintain a proper first aid kit at facility
Staff do not provide residents with activities
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 Representative (FDR), Nessy Abella and explained the purpose of the visit. There were 3 other staff members present at the time of this visit, Leandro Pascual, Joan Taylor, and Estrelita Echavrre.
Current census was 6. 3 out 6 residents were out of the facility at this time. 3 residents were observed outside their bedrooms. 1 resident was in the restroom, 1 resident was working on an activity, and 1 resident was waiting for their transportation.
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: 1 of 3
Control Number 27-AS-20260112085556
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
FACILITY NUMBER: 507004969
VISIT DATE: 04/15/2026
NARRATIVE
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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 confines residents to bedrooms
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. 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.

Allegations: Staff do not follow infection control protocol
It was alleged staff do not follow infection control protocol. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews with 4 staff member, 4 out 4 staff members state that they are aware of the infection control protocol and will initiate the infection control protocol as needed. A review of the facility's infection control protocol was conducted and have found that the facility has a proper infection protocol put in place. Based on the information gathered, there is not sufficient evidence to prove that staff did not follow infection control protocol.

Allegations: Staff do not maintain a proper first aid kit at facility
It was alleged that staff do not maintain a proper first aid kit at the facility. During the course of this investigation, LPA Pascua reviewed the first aid kit at the facility. LPA Pascua observed a thermometer, scissors, Band-Aids, and other components required. Based on the information gathered, there is not sufficient evidence to prove that staff do not maintain a proper first aid kit at the facility.
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: 2 of 3
Control Number 27-AS-20260112085556
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
FACILITY NUMBER: 507004969
VISIT DATE: 04/15/2026
NARRATIVE
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Allegations: Staff do not provide residents with activities
It was alleged that staff do not provide residents with activities. During the course of this investigation, the department conducted staff and residents interviews. 4 out 4 staff members deny that the residents are not provided with activities. An interview with 6 residents were conducted. 6 out 6 residents deny that they do not activities. Based on the information gathered, there is not sufficient evidence to prove that the staff are not provide residents with activities.

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.

An Exit Interview was conducted an a copy of this report was provided to the facility at the end of this visit.
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 3