075601400-7-2-2026-15-AS-BFOG-DVU2CL-20260709171655

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601400
Report Date: 07/02/2026
Date Signed: 07/02/2026 01:37:38 PM

Unfounded

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
04/21/2026 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20260421154634

FACILITY NAME:	ISLAND ANGEL CARE HOME FOR THE ELDERLY		FACILITY NUMBER:	075601400
ADMINISTRATOR:	RAMAIYA, MAVIS		FACILITY TYPE:	740
ADDRESS:	5227 STEVEN S. STROUD DRIVE		TELEPHONE:	(925) 522-8084
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 2	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Mavis Ramaiya, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff sexually abused a resident in care

INVESTIGATION FINDINGS:

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On 07/02/26 at 1PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver the finding of the above allegation. LPA explained the purpose of the visit with ADM.

During investigation, LPA obtained the following documents from administrator – Personnel record (LIC500), Residents roster, Admission agreements, Physician’s reports, Needs & Services plans, Centrally stored medication logs, Progress notes, medical records, daily log notes, incident reports, Police report#26-04-21-0134. Health & safety check conducted see LIC 809 dated 04/22/26.

Continued on next page, LIC 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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-20260421154634

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: ISLAND ANGEL CARE HOME FOR THE ELDERLY	FACILITY NUMBER: 075601400
	VISIT DATE: 07/02/2026

NARRATIVE

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Allegation: Staff sexually abused a resident in care
Investigation Finding: Unfounded
During investigation, the Department conducted interviews of residents (R1, R2), facility staff (LC, S1) and reviewed resident (R1) documents. On 04/21/26, R1 reported to her case manager (CM) that staff (S1) comes in the room at night to have sex with R2 when licensee (LC) was not at the facility. On the same day, LC reported the incident to local police (PD) who investigated and interviewed R1 and R2. R1 stated that what she said to her CM was not true. R2 stated she never had sex with S1.

Review of local police report confirmed that R1 told police that what she said to her case manager (CM) was not true and R2 denied having sex with S1. On 05/18/26, the Department interviewed R2 who again stated she never had sex with S1. Due to R1 recanting her statement and R2 stating she never had sex with S1, local police investigation finding was unfounded. The Department had investigated the complaint alleging that staff sexually abused a resident in care. 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 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: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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