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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200575
Report Date: 03/19/2026
Date Signed: 03/19/2026 01:23:20 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: 105DATE:
03/19/2026
UNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Heather Montgomery, Executive Director/AdministratorTIME COMPLETED:
02:30 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: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
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 5
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: 03/19/2026
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: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/13/2026
Section Cited
CCR
87468.1(a)(12)
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Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(12) To wear their own clothes; to keep and use their own personal possessions, including their toilet articles; and to keep and be allowed to spend their own money.
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By POC due date, ED agrees to allow memory care residents to keep and use their toiletries/personal hygiene items in their apartments. ED agrees to secure doctors' orders for each memory care resident who is not able to keep and use their own toiletries in accordance with Section 87468.1(a)(12).
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This requirement was not met as evidenced by staff locking residents’ toiletries/personal hygiene items which posed a potential health & safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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: 105DATE:
03/19/2026
UNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Heather Montgomery, Executive Director/AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff confined resident to room.
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 pg1
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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: 03/19/2026
NARRATIVE
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Allegation: Staff confined resident to room
Investigation Finding: Unsubstantiated
During unannounced visits on 10/03/24, 11/22/24, 01/15/25, LPA observed memory care residents eat their meals in the common dining areas and participate in group recreational activities assisted by staff. During investigation, former Executive Director (ED) and Memory Care Director (MCD) stated that staff did not confine residents to their room. Staff stated that memory care residents are encouraged/assisted by staff to participate in daily meals and scheduled recreational activities.

On 03/20/26 at 9AM, LPA spoke with third party (W1) who confirmed that on 09/29/24, RP grabbed her cell phone and inputted his contact information without her permission while sitting at a common area in the memory care unit. W1 stated she was very agitated with RP's aggressive behavior, immediately deleted the unwanted information he inputted in her cell phone and reported the incident to management.

Former ED and Risk Manager (RM) stated that they had several discussions with RP regarding his disruptive and threatening behavior towards residents, guests and staff during his visits to the facility. After receiving more complaints from residents, guests and staff about RP’s aggressive behaviors, RM sent a final notice to RP dated 11/12/24 limiting his visits to R1’s apartment only.

Review of resident’s (R1) signed Residency and Service Agreement dated 09/29/23 showed facility staff reserves the right to remove or deny entry to the Community to any visitor whom they determine to be disruptive or dangerous.” Par 23.g.

Based on records review, interviews conducted, and observations made, the Department has investigated the above allegation that staff confined resident to room and found it to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff confined resident to room is unsubstantiated.

Exit interview conducted and a copy of this report provided to ED.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5