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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201319
Report Date: 04/10/2025
Date Signed: 04/10/2025 02:09:29 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/21/2025 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250321171916
FACILITY NAME:ANGELEON CARE HOMEFACILITY NUMBER:
019201319
ADMINISTRATOR:DE LEON, RICHARDFACILITY TYPE:
740
ADDRESS:2124 ASHBY AVENUETELEPHONE:
(650) 692-8945
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY:12CENSUS: 9DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Danilo "Sonny" VillarTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff made inappropriate comments to resident
INVESTIGATION FINDINGS:
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On 04/10/2025 around 01:40 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the finding for the complaint investigation regarding the above allegation. LPA met with Staff, Danilo "Sonny" Villar (S1) and explained the purpose of the visit. Richard De Leon, Administrator (ADM), is not available at this time.

During the visit, LPA requested a copy of the LIC500 (Personnel Report), and resident roster; physician reports, appraisal needs and services, Admission Agreement, House Rules, ID/Emergency Contact sheet, Unusual Incident Reports (UIRs) Medication Administration Records (MARs), and Staff's residential care notes (03/2025) for Residents (R1, R2, R3, R4, R5) on or before 04/02/2025. LPA toured the facility and conducted interviews with Staff (S1, S2) and the above residents.

Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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 2
Control Number 15-AS-20250321171916
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ANGELEON CARE HOME
FACILITY NUMBER: 019201319
VISIT DATE: 04/10/2025
NARRATIVE
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...continued from LIC9099.


Allegation: UNSUBSTANTIATED
Staff made inappropriate comments to resident:

S1 stated that there had not been any threats at the facility and R4 has his/her up and down moments. S2 stated the allegation is untrue. R1 stated that the complaint was from R4 and whomever R4 has imagined. R2 stated that R4 goes from happy and smiling to negative or saying that R4 is being persecuted. S2 stated that R3 was yelling in front of the facility, apologized, but R2 did not indicate a date (R3 was admitted on 12/23/2024). On 02/27/24 R4’s Appraisal Needs and Services Plan (LIC625) states R4 can be easily agitated, and Physician’s Report (LIC602) date 02/13/25 has schizoaffective disorder and needs medication reminders for R4. Case Management conducted on 04/07/25 to address a current LIC625 for R4.

Based on information obtained, the allegation is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that the allegations are not valid because the preponderance of the evidence standard has not been met.

No deficiency cited, exit interview conducted, a copy of this report and appeal rights provided to Staff, Danilo "Sonny" Villar.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2