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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200575
Report Date: 11/18/2025
Date Signed: 03/19/2026 01:31:03 PM

Substantiated


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
09/19/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250919081605
FACILITY NAME:COMMONS AT DALLAS RANCH, THEFACILITY NUMBER:
079200575
ADMINISTRATOR:RFACILITY TYPE:
740
ADDRESS:4751 DALLAS RANCH ROADTELEPHONE:
(925) 754-7772
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:123CENSUS: 107DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Francine Taitano, AdministratorTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Staff did not allow residents access to hygiene products
INVESTIGATION FINDINGS:
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On 03/19/26 at 12:23PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM). LPA explained the purpose of the visit with ADM. This is an AMENDMENT of original complaint report dated 11/18/25.

During investigation, LPA interviewed ED and Memory Care Director (MCD), toured the memory care unit and obtained the following documents: Personnel record (LIC500), Residents' roster, Resident's (R1) admission agreement, Needs & Services plan, 11/12/24 letter regarding visitor’s inappropriate behavior at facility.


Continued on next page, LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
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-20250919081605
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: 11/18/2025
NARRATIVE
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Allegation: Staff did not allow residents access to hygiene products
Investigation Finding: Substantiated
During investigation, LPA observed each memory care resident has their own private bathroom with a sink and a locked cabinet underneath where their personal hygiene items/toiletries such as shampoos, body wash, soap, toothpaste, conditioners, etc. are stored. Staff (former ED, MCD) confirmed with LPA that each memory care resident’s hygiene products are locked inside the cabinet and that memory care residents cannot access their own toiletries, soap, and personal hygiene items without the caregivers using a universal key to unlock the cabinet. Based on LPA’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation that staff did not allow residents access to hygiene products was found to be substantiated.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
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