507004969-7-31-2026-27-AS-LKIG-DWLMXX-20260803100039

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507004969
Report Date: 07/29/2026
Date Signed: 07/31/2026 01:47:20 PM

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
05/17/2026 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260517181046

FACILITY NAME:	DELTA STAR HOME CARE		FACILITY NUMBER:	507004969
ADMINISTRATOR:	OSUKA, ADA P.		FACILITY TYPE:	735
ADDRESS:	2113 QUEBEC COURT		TELEPHONE:	(209) 572-3711
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	6	CENSUS: 6	DATE:	07/29/2026
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Nicetas "Nessy" Radaza		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident sustained an injury due to staff neglect or physical abuse

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 07/29/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Nicetas "Nessy" Radaza. A brief interview was conducted with the facility designated Administrator at this time.
Current census was 6 residents.
The purpose of this visit was to deliver the findings of this complaint investigation to this facility, and it's representative, at this time.
Based on a review of the forms and documents gathered during the course of this investigation, it was learned that R1 attended a day program during the day and was not present at this facility between the hours of 08:00 am to 02:30 pm. It was learned that R1 would leave this facility by early morning and did not return to this facility until after 03:00 pm. It was learned that there weren't any documented pictures or reported incidents where R1 sustained any injuries while in care at this facility. It was learned that on 05/08/2026 an incident report was filed noting that R1 had displayed aggressive behaviors at this facility where facility staff attempted to redirect R1 and had to finally contact the facility designated Administrator

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20260517181046

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: 07/29/2026

NARRATIVE

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who arrived later to this facility.
It was noted in the incident report from this facility that after contacting the facility designated Administrator, Nicetas Radaza, the resident R1 appeared to calm down while waiting for the facility designated Administrator to arrive. It was learned that First Aid was given to R1 since it was observed that R1 has a little cut on R1's chin area. It was learned that this was the only area that required first aid since there weren't any other areas with any cuts, lacerations, or bruising at that time.
It was learned that after the facility designated Administrator arrived at this facility, a brief discussion was held with R1 who wanted to go to the store to buy a drink and some snacks. The facility designated Administrator agreed to taking R1 to the store and R1 was returned to this facility without further incidents.
Based on interviews conducted during the course of this investigation, it was learned that there weren't any injuries sustained by R1 on the indicated date of May 8, 2026. It was learned that R1 could not recall any injuries except for a minor scratch on R'1s chin that R1 stated was self inflicted. It was learned that R1 did not recall any facility staff persons mishandling or mistreating R1 to result in any injuries being sustained.
It was learned that a physical assessment was conducted with R1 in regards to any injuries or wounds sustained on R1's face to which there wasn't any physical evidence to support any inappropriate physical treatment unto R1 at that time.

As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation 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: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026

LIC9099 (FAS) - (06/04)

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