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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601095
Report Date: 07/16/2026
Date Signed: 07/16/2026 01:25:48 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
07/07/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260707165807
FACILITY NAME:HERITAGE ESTATESFACILITY NUMBER:
015601095
ADMINISTRATOR:SUSAN DONAGHYFACILITY TYPE:
740
ADDRESS:900 E STANLEY BLVDTELEPHONE:
(925) 373-3636
CITY:LIVERMORESTATE: ZIP CODE:
94550
CAPACITY:65CENSUS: 61DATE:
07/16/2026
UNANNOUNCEDTIME BEGAN:
12:52 PM
MET WITH:Michael Fillari, General Manager (GM)
Susan Donaghy, Health and Wellness Director (ADM)		TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff neglecting resident
INVESTIGATION FINDINGS:
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On 07/16/26 at 12:35PM, Licensing Program Analyst (LPA) D Panlilio conducted a complaint visit, met with staff (GM, ADM), gathered information and delivered investigation finding to staff. LPA explained the purpose of the visit with staff.

On 07/07/26 and 07/16/26, LPA D Panlilio conducted interviews with reporting party (RP), staff (GM, ADM), reviewed and obtained the following documents: Personnel record (LIC500), Residents roster, R1's admission agreement, appraisals /needs & services plan, physician's report, written 30-day eviction letter and incident reports.

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

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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 2
Control Number 15-AS-20260707165807
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: HERITAGE ESTATES
FACILITY NUMBER: 015601095
VISIT DATE: 07/16/2026
NARRATIVE
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Allegation: Staff are neglecting resident
Investigation Finding: Unsubstantiated
During investigation, LPA D Panlilio conducted interviews with reporting party (RP), facility staff (GM, ADM) and reviewed resident (R1) documents. Review of R1’s admission agreement showed he has been living at the facility since 07/09/2018. On 07/07/26, LPA interviewed RP who stated that staff did not abuse or neglect R1. RP stated they received a written 30-day eviction notice from the facility on 07/02/26 due to R1’s higher level of care needs and steady decline. On 07/16/26, LPA interviewed staff (GM, ADM) who denied neglecting R1’s care and supervision. GM and ADM confirmed with LPA that they issued a written 30-day eviction notice to R1 and his responsible party (POA) on 07/02/26 due to his change in condition which requires a two-person assist with his activities of daily living (ADLs). GM and ADM stated they continue to work closely with R1 and his POA in finding a safe alternative location to meet his higher level of care needs. 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 neglecting resident 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: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2