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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201249
Report Date: 02/18/2026
Date Signed: 02/18/2026 05:02:53 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
02/05/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260205121421
FACILITY NAME:DELTA SHORES ASSISTED LIVINGFACILITY NUMBER:
079201249
ADMINISTRATOR:JARED PICKARDFACILITY TYPE:
740
ADDRESS:825 E 18TH STREETTELEPHONE:
(925) 706-7944
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:90CENSUS: 85DATE:
02/18/2026
UNANNOUNCEDTIME BEGAN:
04:26 PM
MET WITH:Jared Pickard, AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff do not treat resident with respect
Staff do not intervene when residents bully other residents
INVESTIGATION FINDINGS:
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On 02/18/26 at 4PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit, met with staff (ED, S1), gathered information and delivered investigation findings to ED. LPA explained the purpose of the visit with ED.

On 02/12/26 at 2:15PM, LPA conducted interviews with staff (ED, S1, S2, S3, S4, S5, S6) and residents (R1, R2, R3, R4) and obtained the following documents: Personnel record (LIC500), Residents roster, R1's admission agreement, appraisals /needs & services plan, physician's report, progress notes, centrally stored medication logs, medication administration records and incident reports.

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

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
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 3
Control Number 15-AS-20260205121421
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: DELTA SHORES ASSISTED LIVING
FACILITY NUMBER: 079201249
VISIT DATE: 02/18/2026
NARRATIVE
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Allegation: Staff do not treat resident with respect
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP), residents (R1, R2, R3, R4) and facility staff (ED, S1, S2, S3, S4, S5, S6) and reviewed resident (R1) documents. Staff (ED, S1, S2, S3, S4, S5, S6) denied calling R1 derogatory remarks and did not witness other residents bully him. R3 stated she has been living at the facility since July 2025 and is constantly with R1 eating their daily meals at the common dining hall and participating in recreational activities together with other residents and staff. R3 stated she did not witness any resident or staff call R1 names or bully him. R3 stated that R1 is experiencing paranoia and would not listen to her. ED and S6 also stated they did not observe any resident or staff calling R1 derogatory remarks or bully him while in care. Other staff (S1, S2, S3, S4, S5) and residents (R2, R3, R4) denied making derogatory remarks towards R1 or harass him. RP also stated that she did not observe R1 being called derogatory names or being bullied by staff during visits. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff do not treat resident with respect is unsubstantiated.

Continued on next page, LIC 9099-C pg1
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20260205121421
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: DELTA SHORES ASSISTED LIVING
FACILITY NUMBER: 079201249
VISIT DATE: 02/18/2026
NARRATIVE
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Allegation: Staff do not intervene when residents bully other residents
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP), residents (R1, R2, R3, R4) and facility staff (ED, S1, S2, S3, S4, S5, S6) and reviewed resident (R1) documents. Staff (S1, S2) stated they would greet R1 at the start of their recreational activities with “Good Morning, how are you” and he would get agitated and reply back to them that they were calling him derogatory remarks and bullying him. Staff denied calling him names or bullying him. Staff (S1, S2, S3, S4, S5, S6) stated they always intervene and redirect residents whenever there is an argument or agitation among residents. R3 stated she is with R1 at the facility during meals and recreational activities daily. She stated she did not observe any resident or staff call R1 names or bully him. Other residents (R2, R3, R4) also stated that they did not witness any resident or staff bully R1 or call him names. Review of incident reports dated 01/20/26 and 02/11/26 showed staff intervened and redirected aggressive residents from other residents and staff notified responsible parties, primary care physicians and called 911 for evaluation and treatment. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff do not intervene when residents bully other residents is unsubstantiated.

No deficiencies 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: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3