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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201172
Report Date: 08/20/2025
Date Signed: 08/20/2025 03:04:37 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
08/13/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250813184430
FACILITY NAME:FRIENDSHIP CARE HOMEFACILITY NUMBER:
079201172
ADMINISTRATOR:SANDHU, SEEMAFACILITY TYPE:
740
ADDRESS:1907 CAVALLO ROADTELEPHONE:
(925) 732-7364
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:35CENSUS: 31DATE:
08/20/2025
UNANNOUNCEDTIME BEGAN:
02:43 PM
MET WITH:Cynthia Murphy, Administrator/Facility NurseTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility does not have enough afternoon and night staff to meet residents needs
Facility is not equipped to serve residents in dining area
Administrator is not at the facility a sufficient number of hours per week
INVESTIGATION FINDINGS:
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On 08/20/25 at 2:45PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with staff (ADM, S1), gathered information and delivered investigation findings to ADM, S1. LPA explained the purpose of the visit with staff.

During investigation, LPA conducted interviews with reporting party (RP), staff (ADM, S1) and obtained the following documents from administrator – Personnel record (LIC500), Residents roster, incident reports.

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: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
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 5
Control Number 15-AS-20250813184430
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: FRIENDSHIP CARE HOME
FACILITY NUMBER: 079201172
VISIT DATE: 08/20/2025
NARRATIVE
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Allegation: Facility does not have enough afternoon and night staff to meet residents’ needs
Investigation Finding: Substantiated
During investigation, LPA conducted interviews with reporting party (RP), staff (ADM, S1) and reviewed facility’s personnel record (LIC500), work schedules and residents’ roster. Review of residents’ roster (LIC9020) showed a total of 33 residents residing at the facility. Staff (S1) confirmed with LPA that there is not enough staff in the PM and Night (NOC) shifts to meet residents’ care needs. S1 stated that there is 1 medtech and 2 caregivers in the PM shift and 1 medtech and 1 caregiver in the NOC shift. S1 also stated that approximately 11 of the 33 residents require 2+assist. 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(s) that facility does not have enough PM and NOC staff to meet residents’ needs was found to be substantiated.

Allegation: Facility is not equipped to serve residents in the dining area
Investigation Finding: Substantiated
During investigation, LPA conducted interviews with reporting party (RP), staff (ADM, S1) and LPA A Gomez. Prior unannounced visits conducted by LPA A Gomez on 07/01/25, 07/24/25 and 08/13/25 showed that LPAs observed the facility’s dining room area only had 4 tables that could seat 4 residents at any given time and that staff was using the activities/TV room area to feed the other residents. On 08/15/25, LPA confirmed with S1 that ADM has not purchased the additional dining tables for residents’ use and has not implemented a dining plan to properly feed all residents for each meal without using the activities/TV room for residents’ meals.. Based on LPAs’ observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that facility is not equipped to serve residents in the dining area was found to be substantiated.

Continued on next page, LIC 9099-C
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20250813184430
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: FRIENDSHIP CARE HOME
FACILITY NUMBER: 079201172
VISIT DATE: 08/20/2025
NARRATIVE
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Allegation: Administrator is not at the facility a sufficient number of hours per week
Investigation Finding: Substantiated
During investigation, LPA conducted interviews with reporting party (RP), staff (S1) and LPA A Gomez. Prior unannounced visits conducted by LPAs on 05/21/25, 07/24/25 and 08/13/25 showed that LPAs observed ADM was not present at the facility during these visits. S1 stated that ADM comes to the facility 1 to 2 times per week for about an hour and then leaves. Based on LPAs’ observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that Administrator is not at the facility a sufficient number of hours per week was found to be substantiated.

Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POCs) by plan of correction due dates 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: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20250813184430
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: FRIENDSHIP CARE HOME
FACILITY NUMBER: 079201172
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2025
Section Cited
CCR
87411(a)
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Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs…
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By POC due date, ADM agrees to hire additional staffing for PM and NOC shifts and submit to CCLD an updated Personnel record (LIC500) showing additional staff in compliance with Section 87411 (a) regulation
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This requirement was not met as evidenced by facility does not have enough afternoon and night staff to meet residents’ need which posed a potential health & safety risk to residents in care.
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Type B
09/19/2025
Section Cited
CCR
87307(d)(1)
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The following space and safety provisions shall apply to all facilities: Sufficient room shall be available to accommodate persons served in comfort and safety.
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By POC due date, ADM agrees to purchase additional dining tables to accommodate residents’ dining needs and submit to CCLD an updated dining plan in compliance with Section 87307 (d)(1) regulation
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This requirement was not met as evidenced by facility is not equipped to serve residents in the dining area
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: 08/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250813184430
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: FRIENDSHIP CARE HOME
FACILITY NUMBER: 079201172
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2025
Section Cited
CCR
87405(a)
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The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.
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By POC due date, ADM agrees to be at the facility a sufficient number of hours (minimum 20 hours per week) to permit adequate attention to the management and administration of the facility. ADM agrees to complete and submit to CCLD updated Personnel record (LIC 500) showing Administrator's sufficient number of work hours per week at the facility (minimum 20 hours per week) in compliance with Section 87405(a) regulation.
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This requirement was not met as evidenced by administrator is not at the facility a sufficient number of hours per week 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: 08/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5