079201249-2-18-2026-15-AS-BFOG-DRP3EF-20260226171100

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201249
Report Date: 02/18/2026
Date Signed: 02/18/2026 05:03:47 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
02/17/2026 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20260217164311

FACILITY NAME:	DELTA SHORES ASSISTED LIVING		FACILITY NUMBER:	079201249
ADMINISTRATOR:	JARED PICKARD		FACILITY TYPE:	740
ADDRESS:	825 E 18TH STREET		TELEPHONE:	(925) 706-7944
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	90	CENSUS: 85	DATE:	02/18/2026
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Jared Pickard, Administrator		TIME COMPLETED:	06:30 PM

ALLEGATION(S):

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Facility staff do not ensure that residents are provided with activities

INVESTIGATION FINDINGS:

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On 02/18/26 at 5PM, Licensing Program Analyst (LPA) D Panlilio conducted a complaint visit, met with staff (ED, S1, S2), gathered information and delivered investigation finding to ED. LPA explained the purpose of the visit with ED.

On 02/18/26 at 5:15PM, LPA conducted interviews with staff (ED, S1, S2) and residents (R1, R2, R3, R4) and obtained the following documents: Personnel record (LIC500), Residents roster, monthly activities schedules.

Continued on next page, LIC9099-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)

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Control Number 15-AS-20260217164311

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: Facility staff do not ensure that residents are provided with activities
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with residents (R1, R2, R3, R4) and facility staff (ED, AD, RA1, RA2, RA3) and reviewed recreational activities' February and March 2026 daily schedules. ED stated they have an Activities Director (AD) and Recreational Assistants (AD, RA1, RA2, RA3) who engage residents in daily recreational activities such as current event, sit & fit, bingo, music, Karaoke, trivia games, balloon toss, corn hole, movie nights, puzzles, exercise, arts & crafts. AD stated there are three recreational assistants (RA1, RA2, RA3) who help residents participate in the facility’s daily recreational activities.

At 5:10PM, recreational staff (AD, RA1, RA2, RA3) confirmed with LPA that they inform residents of the monthly recreational schedules by posting them inside their bedrooms as well as in the activities area to allow them the opportunity to participate in the daily recreational activities. Residents (R1, R2, R3, R4) stated they participate in the facility’s daily recreational activities while other residents prefer to smoke outside or rest inside their rooms. Review of facility’s monthly recreational activities’ schedule showed a variety of activities such as bingo, exercise, arts & crafts, movie nights, balloon toss, Karaoke, trivia games, puzzles, nail coloring, pool noodle toss, sip & paint offered for residents to participate in. 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 facility staff do not ensure that residents are provided with activities 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)

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