507004970-9-15-2021-27-AS-SHUT-C6W7FB-20210915213715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 507004970
Report Date: 09/15/2021
Date Signed: 09/15/2021 09:37:43 PM

Document Has Been Signed on 09/15/2021 09:37 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	DELTA STAR - MERCER HOME CARE		FACILITY NUMBER:	507004970
ADMINISTRATOR:	OSUKA, FESTUS J		FACILITY TYPE:	735
ADDRESS:	4124 MERCER DRIVE		TELEPHONE:	(209) 846-9871
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY: 6		CENSUS: 5	DATE:	09/15/2021
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Fetus "John" Osuka		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An office meeting was conducted today in the Sacramento Regional Office via Microsoft Teams. The purpose of this meeting was to discuss audit compliance. Present at the meeting were Regional Manager (RM) Krystall Moore, Licensing Program Manager(s) Stephenie Doub and Harpreet Humpal, Licensing Program Analyst(s) (LPA) Sarah Hurt and Grace Luk, Jacqueline Juarez and Jessica Chen Auditors, Fetus "John" Osuka representatives of Delta Star Home Care LLC and Jacob Reinhardt attorney representing Delta Star Home Care LLC. On June 2, 2021 an office meeting was held where it was agreed that the licensee would provide monthly documentation to the audit department for solvency monitoring. These documents were to be submitted quarterly and were due on July 15, 2021 but have yet to be received by the Department. Prior to this meeting, the licensee did provide some documents but advised that the information was not complete. The licensee representatives agreed to the following to remain in compliance: · submit audit monitoring documentation for Quarter 2 by close of business September 17, 2021 · continue to provide documentation quarterly, with the next documents due on October 15, 2021 · communicate with the Department should an extension be needed to provide documents · provide proof of workmen's compensation insurance by September 30, 2021 · financial monitoring would be conducted for one year Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was conducted with representative John Osuka via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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

LIC809 (FAS) - (06/04)

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