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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507004970
Report Date: 02/14/2022
Date Signed: 02/21/2022 09:50:51 PM

Document Has Been Signed on 02/21/2022 09:50 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 CAREFACILITY NUMBER:
507004970
ADMINISTRATOR:OSUKA, FESTUS JFACILITY TYPE:
735
ADDRESS:4124 MERCER DRIVETELEPHONE:
(209) 846-9871
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 6CENSUS: 4DATE:
02/14/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee , Jon OsukaTIME COMPLETED:
03:00 PM
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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, 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.
Auditor Jessica Chen reviewed audit findings. The audit findings show despite one bank account having a large sum of cash savings there are several smaller bank accounts that are overdrawn consistently and being charged insufficient funds fees.The licensee is consistently paying utilities, and facility mortgages late. The licensee has not submitted workers compensation insurance for facility Paradise Residential. The financial monitoring will continue until audit findings show Licensee is financially solid as required.

The licensee representatives agreed to the following to remain in compliance:
· submit solid financial plan ensuring utilities are paid on time, and accounts are not being overdrawn by March 4, 2022.
· submit financial documents for next quarter by June 15, 2022
· provide proof of workmen's compensation insurance for Paradise Residential immediately.
· financial monitoring will continue until Licensee is proven to be financially solvent.

Per California Code of Regulations (CCR) - 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: 02/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2022
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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