079201340-1-21-2026-15-AS-BFOG-DRL3J4-20260223171651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201340
Report Date: 01/21/2026
Date Signed: 01/21/2026 03:21:07 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
12/30/2025 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20251230120118

FACILITY NAME:	ESTHER ANGELS CARE HOME		FACILITY NUMBER:	079201340
ADMINISTRATOR:	ACHOLONU, ROSE C.		FACILITY TYPE:	740
ADDRESS:	1403 PREWETT RANCH DR.		TELEPHONE:	(500) 435-8093
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 4	DATE:	01/21/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Rose Acholonu, Administrator		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff left resident in soiled bedding
Staff did not ensure resident’s cup was free of mold
Staff did not ensure the facility was not in financial distress

INVESTIGATION FINDINGS:

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On 01/21/26 at 12:30PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit, met with staff (ADM, S1), gathered information and delivered investigation findings to ADM. LPA explained the purpose of the visit with staff.

During investigation, LPA conducted interviews with reporting party (RP/DPOA), staff (ADM, S1, S2) and obtained the following documents from ADM – Personnel record (LIC500), Residents roster, admission agreement, physician’s report, needs & services plan, physician's report, medication administration records, blood sugar logs, ID/Emergency information, Progress Notes.

Continued on next page, LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

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 8

Control Number 15-AS-20251230120118

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: ESTHER ANGELS CARE HOME	FACILITY NUMBER: 079201340
	VISIT DATE: 01/21/2026

NARRATIVE

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Allegation: Staff left resident in soiled bedding
Investigation Finding: Substantiated
During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. LPA interviewed RP who shared a photo taken while R1 was residing at the facility showing R1 wearing a soiled diaper with dried brown diarrhea on the side her buttocks as she rested on a soiled bed cover. 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 staff left resident in soiled bedding was found to be substantiated.

Allegation: Staff did not ensure resident’s cup was free of mold
Investigation Finding: Substantiated
During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) records. LPA analyzed two photos of R1's sippy cup which showed the presence of black mold inside the sipping straw and around the inside rim of R1’s stainless steel tumbler. 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 staff did not ensure resident’s cup was free of mold was found to be substantiated.

Continued on next page, LIC9099-C pg1

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 8

Control Number 15-AS-20251230120118

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: ESTHER ANGELS CARE HOME	FACILITY NUMBER: 079201340
	VISIT DATE: 01/21/2026

NARRATIVE

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Allegation: Staff did not ensure the facility was not in financial distress
Investigation Finding: Substantiated
During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. LPA interviewed RP who shared a photo of a water shutoff notice from the City of Antioch given to the facility dated 09/30/25 due to non-payment of service. S1 stated that water was cut off because ADM forgot to pay the water bill. RP also stated that on 11/12/25, the power was shut off by PG&E. S1 stated that ADM forgot to pay the monthly PG&E bill and that they were without power for approximately 10 hours until the bill was paid. 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 staff did not ensure the facility was not in financial distress 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 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: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 8

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
12/30/2025 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20251230120118

FACILITY NAME:	ESTHER ANGELS CARE HOME		FACILITY NUMBER:	079201340
ADMINISTRATOR:	ACHOLONU, ROSE C.		FACILITY TYPE:	740
ADDRESS:	1403 PREWETT RANCH DR.		TELEPHONE:	(500) 435-8093
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 4	DATE:	01/21/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Rose Acholonu, Administrator		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff did not ensure resident had video conference with physician
Staff did not notice resident’s change in condition
Staff did not seek medical attention for resident
Staff did not ensure they repositioned resident

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

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

LIC9099 (FAS) - (06/04)

Page: 4 of 8

Control Number 15-AS-20251230120118

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: ESTHER ANGELS CARE HOME	FACILITY NUMBER: 079201340
	VISIT DATE: 01/21/2026

NARRATIVE

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Allegation: Staff did not ensure resident had video conference with physician
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. LPA interviewed ADM who stated that she spoke with RP regarding the missed doctor video chat with R1 on 12/03/25. ADM stated she offered to assist RP and R1 reschedule the video call with her primary care physician. However, ADM stated RP did not follow-up with her again on the rescheduled video call. Review of text messages between RP and S1 in December 2025 showed staff informed RP that the facility phone did not have video chat capability to assist R1 with her scheduled doctor's video chat health evaluation on 12/03/25. Staff (ADM, S1) also stated that they offered to answer any questions during R1’s video chat to assist in R1’s health evaluation. 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 did not ensure resident had video conference with physician is unsubstantiated.

Allegation: Staff did not notice resident’s change in condition

Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP/DPOA), staff (S1, S2) and reviewed resident (R1) documents. RP stated she visited R1 the past two weeks in December 2025 and observed R1 having belly pain, loss of appetite, unable to sit up, incoherent and weak. RP stated she communicated her concerns about R1’s health condition with staff (ADM, S1, S2) in December 2025. On 12/03/25, ADM stated she spoke with RP and told her that R1 stated she was OK and did not want to see the doctor. ADM stated R1 told the staff she does not want to call the paramedics or 911. LPA interviewed staff (S1) who stated that they did not notice anything wrong with R1 while in care. 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 did not notice resident’s change in condition is unsubstantiated.

Continued on next page, LIC9099-C pg2

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 8

Control Number 15-AS-20251230120118

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: ESTHER ANGELS CARE HOME	FACILITY NUMBER: 079201340
	VISIT DATE: 01/21/2026

NARRATIVE

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Allegation: Staff did not seek medical attention for resident
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. LPA interviewed RP who stated that she observed R1’s belly was distended for the past two visits. On 12/13/25, RP stated she observed R1 was barely able to tell her that it hurts when she applies pressure on her belly and noticed something was not right. She communicated R1’s concerns with staff (ADM, S1, S2) who offered to call the paramedics or take R1 to see her primary care physician. Staff (ADM, S1) stated that R1 refused to call the paramedics and told them she was fine and feeling well. 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 did not seek medical attention for resident is unsubstantiated.

Allegation: Staff did not ensure they repositioned resident

Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. Review of R1’s physician’s report and needs & services plan dated 07/02/25 did not show presence of any pressure injuries upon admission. Staff (ADM, S1) stated they repositioned R1 3X per day and that R1 did not have any pressure injuries while in care. 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 did not ensure they repositioned resident is unsubstantiated.

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: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 8

Control Number 15-AS-20251230120118

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: ESTHER ANGELS CARE HOME	FACILITY NUMBER: 079201340
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/21/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/20/2026 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.	1 2 3 4 5 6 7	By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on proper resident reappraisal in compliance with Section 87468.2(a)(4)
	8 9 10 11 12 13 14	This requirement was not met as evidenced by staff left resident in soiled bedding which posed a potential health & safety risk to resident in care.	8 9 10 11 12 13 14
Type B 02/20/2026 Section Cited CCR 87555(a)	1 2 3 4 5 6 7	All food shall be selected, stored, prepared and served in a safe and healthful manner.	1 2 3 4 5 6 7	By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on proper resident reappraisal in compliance with Section 87555(a)
	8 9 10 11 12 13 14	This requirement was not met as evidenced by staff did not ensure resident’s cup was free of mold which posed a potential health & safety risk to resident in care.	8 9 10 11 12 13 14

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: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 8

Control Number 15-AS-20251230120118

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: ESTHER ANGELS CARE HOME	FACILITY NUMBER: 079201340
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/21/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/20/2026 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	By POC due date, ADM agrees to complete and submit to CCLD proof of water & PG&E paid statements for December 2025 and January 2026 with automatic payment scheduled every month to ensure the health and safety of residents are not compromised and facility is in compliance with Section 87303(a).
	8 9 10 11 12 13 14	This requirement was not met as evidenced by staff did not ensure the facility was not in financial distress which posed a potential health & safety risk to resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC9099 (FAS) - (06/04)

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