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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201367
Report Date: 10/08/2025
Date Signed: 10/08/2025 05:19:18 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
10/03/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20251003001627
FACILITY NAME:DLC ELDERLYFACILITY NUMBER:
079201367
ADMINISTRATOR:DE LA CRUZ, WILFREDFACILITY TYPE:
740
ADDRESS:5501 PINNACLE VIEW WAYTELEPHONE:
(925) 787-4431
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 6DATE:
10/08/2025
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Wilfred De La Cruz, AdministratorTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Staff did not transfer a resident in care
INVESTIGATION FINDINGS:
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On 10/08/25 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information and delivered investigation finding to ADM.. LPA explained the purpose of the visit with ADM.

During investigation, LPA interviewed reporting party (RP), facility staff (ADM, S1) and obtained the following documents from ADM: Personnel record (LIC500), Residents' roster, admission agreements, physician's reports, Needs & Services plans.

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: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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 2
Control Number 15-AS-20251003001627
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: DLC ELDERLY
FACILITY NUMBER: 079201367
VISIT DATE: 10/08/2025
NARRATIVE
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Allegation: Staff did not transfer a resident in care
Investigation Finding: Unsubstantiated
During investigation, LPA interviewed reporting party (RP), residents (R1,R2), facility staff (ADM, S1, S2, S3) and reviewed R1’s documents. Review of R1's admission agreement dated 12/18/24 showed resident (R1) was first admitted at the facility on 01/03/25. At 3:30PM, LPA interviewed residents (R1, R2) who stated that staff assist them with their activities of daily living (transferring in and out of bed, showering, toileting, grooming, feeding, dressing, incontinence care, medications) and that staff provide them with excellent care. ADM stated that the Home Health team for R1 never offered staff to train them in his mobility care. S1 and S2 stated that they were already trained to properly use the Hoyer lifts by R2's prior Home Health therapists. At 5PM, LPA observed S1, S2 properly assisted R1 and R2 with transfers in and out of bed using the Hoyer lifts, incontinence care and feeding them dinner during visit. LPA observed R1 and R2 were comfortable with staff assisting them with the transfers using the Hoyer lifts. 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 transfer a resident in care is unsubstantiated.

No deficiency 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: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
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