079201256-8-12-2025-15-AS-BFOG-DKNSD2-20250818134626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201256
Report Date: 08/12/2025
Date Signed: 08/12/2025 04:24:02 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
08/11/2025 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20250811112107

FACILITY NAME:	A LOVING HOME		FACILITY NUMBER:	079201256
ADMINISTRATOR:	ALOOT, DONNIE		FACILITY TYPE:	740
ADDRESS:	3420 CLAYBURN RD.		TELEPHONE:	(951) 522-1228
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	6	CENSUS: 4	DATE:	08/12/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Donnie Aloot, Administrator		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Staff are not meeting residents nutritional needs

INVESTIGATION FINDINGS:

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On 08/12/25 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information and delivered investigation findings of above allegations. LPA explained the purpose of the visit with ADM.

During investigation, LPA obtained the following documents from ADM - staff roster, residents’ roster, admission agreement, physicians report, ID/Emergency information, Needs & Services plan, meal plans and maintenance records.

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: 08/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

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 4

Control Number 15-AS-20250811112107

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: A LOVING HOME	FACILITY NUMBER: 079201256
	VISIT DATE: 08/12/2025

NARRATIVE

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Allegation: Staff are not meeting resident’s nutritional needs
Investigation Finding: Unsubstantiated
On 08/12/25 at 1PM, LPA interviewed staff (ADM, S1) and residents (R1, R2, R3). ADM stated staff follows prescribed special diet requirements for residents. S1 stated he prepares low carbohydrate and gluten free meals for R1, meals rich in protein for R2 since he is on dialysis and soft minced diet for R3 since he has no upper and lower teeth. R1, R2, R3 confirmed with LPA that staff provide them 3 meals each day with snacks and drinks in between meals. LPA observed facility has sufficient 2-day perishables (fresh fruits, vegetables, eggs, milk, juices, gluten free bread, pies, various meats) and 7-day non-perishable food supply. LPA observed residents are hydrated, well nourished, odor free, and comfortable in their surroundings. 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 are not meeting resident’s nutritional needs is unsubstantiated.

No deficiency cited during visit. Exit interview conducted and a copy of the report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
08/11/2025 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20250811112107

FACILITY NAME:	A LOVING HOME		FACILITY NUMBER:	079201256
ADMINISTRATOR:	ALOOT, DONNIE		FACILITY TYPE:	740
ADDRESS:	3420 CLAYBURN RD.		TELEPHONE:	(951) 522-1228
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	6	CENSUS: 4	DATE:	08/12/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Donnie Aloot, Administrator		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Facility outlets are in disrepair with exposed wires

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 15-AS-20250811112107

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: A LOVING HOME	FACILITY NUMBER: 079201256
	VISIT DATE: 08/12/2025

NARRATIVE

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Allegation: Facility outlets are in disrepair with exposed wires
Investigation Finding: Unfounded
During investigation, LPA toured the facility including but not limited to residents’ bedrooms, bathrooms, kitchen, dining and living room areas. LPA did not observe any exposed wires present at the facility on 08/12/25.

LPA also reviewed prior Complaint 15- AS-20250605113309 dated 06/13/25 which showed facility replaced all ungrounded electrical outlets with three prong grounded outlets inside the home (all resident's bedrooms, bathrooms, hallways, dining and kitchen areas) on 06/14/25.

On LPA’s prior unannounced visit dated 06/13/25. LPA observed resident (R1) had several devices (medical monitoring device, TV, phone charger) plugged into a surge protector strip which is connected to the wall outlet. LPA did not observe any exposed wires from the electrical outlets.

The Department had investigated the complaint alleging that facility outlets are in disrepair with exposed wires. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

No deficiencies cited. Exit Interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

LIC9099 (FAS) - (06/04)

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