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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200989
Report Date: 10/21/2025
Date Signed: 10/21/2025 05:26:21 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
10/16/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20251016181905
FACILITY NAME:ZANNAT BOARDING CARE, INCFACILITY NUMBER:
079200989
ADMINISTRATOR:KAUR, NAVDEEPFACILITY TYPE:
740
ADDRESS:5257 MOHICAN WAYTELEPHONE:
(510) 932-6827
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 5DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Navdeep Kaur, AdministratorTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Staff are utilizing an object to lock facility door from inside.
INVESTIGATION FINDINGS:
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On 10/21/25 at 4PM, Licensing Program Analyst (LPA) D Panlilio conducted a complaint visit, gathered information and delivered investigation finding to administrator (ADM). LPA explained the purpose of the visit with ADM.

Allegation: Staff are utilizing an object to lock facility door from inside
Finding: Substantiated
During investigation, LPA interviewed reporting party (RP), facility staff (S1) and toured the facility. On 10/21/25 at 4:10PM, LPA observed S1 securing the front door bolt and handle with a plastic insert lock stopper. S1 stated they have a resident who always wants to leave the facility, so they use the plastic insert lock stopper to prevent her from exiting the facility.

Continued on next page, LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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 3
Control Number 15-AS-20251016181905
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: ZANNAT BOARDING CARE, INC
FACILITY NUMBER: 079200989
VISIT DATE: 10/21/2025
NARRATIVE
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Based on interviews and observations which were conducted, the preponderance of evidence standard has been met and the above allegation(s) that staff are utilizing an object to lock facility door from the inside is 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: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20251016181905
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: ZANNAT BOARDING CARE, INC
FACILITY NUMBER: 079200989
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2025
Section Cited
CCR
87468.1(a)(6)
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To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...
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By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on residents' personal rights in compliance with Section 87468.1(a)(6).
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This requirement was not met as evidenced by staff using a plastic lock over the front door bolt and handle to prevent residents from leaving the facility which pose 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: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3