079200575-2-5-2025-15-AS-BFOG-DE22FN-20250218162149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200575
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:46:24 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
11/21/2024 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20241121091034

FACILITY NAME:	COMMONS AT DALLAS RANCH, THE		FACILITY NUMBER:	079200575
ADMINISTRATOR:	BRITTANY KARLINSKI		FACILITY TYPE:	740
ADDRESS:	4751 DALLAS RANCH ROAD		TELEPHONE:	(925) 754-7772
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	123	CENSUS: 101	DATE:	02/05/2025
		UNANNOUNCED	TIME BEGAN:	01:37 PM
MET WITH:	Francine Taitano, Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not afford a resident privacy while in care

INVESTIGATION FINDINGS:

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On 02/05/25 at 01:10PM, LPA D Panlilio conducted a subsequent visit to amend the complaint deliverd on 01/15/25. LPA met with executive director (ED) and explained the purpose of the visit.

During investigation, the department obtained the following documents from administrator – Personnel record (LIC500), Residents' roster, Resident's (R1) admission agreement, physician's reports, Needs & Services plans, appraisals, incident reports.

Continued on next page, LIC 9099-C

Exit interview conducted and copy of this report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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 15-AS-20241121091034

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: COMMONS AT DALLAS RANCH, THE	FACILITY NUMBER: 079200575
	VISIT DATE: 02/05/2025

NARRATIVE

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Allegation: Staff did not afford a resident privacy while in care
Investigation Finding: Unsubstantiated
During investigation, the department conducted interviews of facility staff (ED, S1) & responsible party and reviewed resident (R1) documents and video recording dated 08/01/24. LPA interviewed reporting party (POA) who stated that on 08/01/24 at approximately 7:40AM a care provider was seen on video, inappropriately looking in R1's closets and dresser drawers (all of which contained her personal belongings and effects) without expressed permission by R1. LPA interviewed staff (S1) who stated that on 08/01/24, R1 was having breakfast at around 7:30AM in the common dining area when she was asked by R1 to get something from her room. She did not remember what the item was she was looking for and left the room. S1 denied violating R1’s privacy. Although the allegation that staff did not afford a resident privacy while in care may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, this allegation is unsubstantiated.

No deficiency cited during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC9099 (FAS) - (06/04)

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