515002949-1-22-2025-59-AS-TORZ-DDG2ZB-20250131165001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 515002949
Report Date: 01/22/2025
Date Signed: 01/22/2025 02:58:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
10/14/2024 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 59-AS-20241014221354

FACILITY NAME:	DELTA AT HOLLY OAKS		FACILITY NUMBER:	515002949
ADMINISTRATOR:	LEONARD WILLIS II		FACILITY TYPE:	735
ADDRESS:	1880 LIVE OAK BLVD		TELEPHONE:	(530) 618-5615
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95991
CAPACITY:	70	CENSUS: 53	DATE:	01/22/2025
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Leonard Willis II		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff did not prevent a client from having access to illegal drugs

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kerry Hiratsuka and Cassendra Mikkelson, conducted this visit to deliver the results of the allegation above.

Community Care Licensing Division (CCLD) conducted the investigation into the allegations above.

CCLD interviewed staff, resident in question (R1), witnesses, and reviewed R1’s file. R1 is able to leave the facility without assistance per the primary care doctor. The witnesses are aware R1 is able to leave the facility without assistance. The facility staff policy for residents is they cannot physically search the person without consent and cannot search resident rooms without consent of the resident. CCLD is unable to determine when and where R1 obtained the drugs, when R1 took them, and whether staff were able to prevent R1 from having access to the illegal drugs in the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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 59-AS-20241014221354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DELTA AT HOLLY OAKS	FACILITY NUMBER: 515002949
	VISIT DATE: 01/22/2025

NARRATIVE

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Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No citations were issued during this visit.
Exit interview was conducted with Administrator and a copy of this report was provided to the facility.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC9099 (FAS) - (06/04)

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