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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200235
Report Date: 10/16/2025
Date Signed: 10/16/2025 03:10:00 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
09/22/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250922154601
FACILITY NAME:BUENAVISTA HOME AT HILLCRESTFACILITY NUMBER:
079200235
ADMINISTRATOR:RONALDO PEREZFACILITY TYPE:
735
ADDRESS:5517 SUNVIEW WAYTELEPHONE:
(925) 777-3880
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 6DATE:
10/16/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Ronaldo Perez, AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff pushed resident
INVESTIGATION FINDINGS:
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On 10/16/25 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver findings of above allegations. LPA explained the purpose of the visit with ADM.

During investigation, LPA interviewed reporting party (RP), staff (ADM, S1, S2), clients (C1, C2, C3, C4) and obtained the following documents from administrator: Personnel record (LIC500), Client roster (LIC 9020), C1 admission agreement, physician's report, ISP/IPP plan, functional assessment, incident reports.

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

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
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 5
Control Number 15-AS-20250922154601
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: BUENAVISTA HOME AT HILLCREST
FACILITY NUMBER: 079200235
VISIT DATE: 10/16/2025
NARRATIVE
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Allegation: Staff pushed resident
Finding: Substantiated
During investigation, LPA interviewed reporting party (RP), facility staff (ADM, S1, S2), clients (C1, C2, C3, C4) and reviewed C1’s documents. Review of the incident dated 09/20/25 captured on video showed S2 pushing C1 against the back of the transport van and again against the closed garage door while guiding him towards the front entrance of the facility. ADM and S1 confirmed with LPA that on 09/20/25 the other four (4) clients already exited the van and entered the facility leaving C1 still sitting inside the van when this incident occurred. No other staff was present outside the front of the facility during the incident. Staff (ADM, S1) were not aware that this incident occurred until police conducted a welfare check at the facility on 09/22/25. Based on interviews and record reviews which were conducted, the preponderance of evidence standard has been met and the above allegation(s) that staff pushed resident was found to be substantiated.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) 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: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
09/22/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250922154601

FACILITY NAME:BUENAVISTA HOME AT HILLCRESTFACILITY NUMBER:
079200235
ADMINISTRATOR:RONALDO PEREZFACILITY TYPE:
735
ADDRESS:5517 SUNVIEW WAYTELEPHONE:
(925) 777-3880
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 6DATE:
10/16/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Ronaldo Perez, AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit resident
INVESTIGATION FINDINGS:
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2
3
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5
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9
10
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13
On 10/16/25 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver findings of above allegations. LPA explained the purpose of the visit with ADM.

During investigation, LPA interviewed reporting party (RP), staff (ADM, S1, S2), clients (C1, C2, C3, C4) and obtained the following documents from administrator: Personnel record (LIC500), Client roster (LIC 9020), C1 admission agreement, physician's report, ISP/IPP plan, functional assessment, incident reports.

Continued on next page, LIC 9099-C pg2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
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 5
Control Number 15-AS-20250922154601
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: BUENAVISTA HOME AT HILLCREST
FACILITY NUMBER: 079200235
VISIT DATE: 10/16/2025
NARRATIVE
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Allegation: Staff hit resident
Finding: Unsubstantiated
During investigation, LPA interviewed reporting party (RP), facility staff (ADM, S1, S2), clients (C1, C2, C3, C4) and reviewed C1’s documents. RP stated she witnessed S2 slap C1 in the head and mouth while C1 was trying to get out of the transport van on 09/20/25. Review of the incident dated 09/20/25 captured on video showed no record of staff (S2) hitting client (C1) on the head or mouth. S2 denied hitting C1 in the head or mouth. S2 stated he did not have any malicious intent when he pushed C1 back inside the van because he was trying to avoid C1 falling on him. ADM stated he conducted an internal investigation regarding the incident and terminated S2 on 10/01/25. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the above allegation that staff hit resident is unsubstantiated.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250922154601
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: BUENAVISTA HOME AT HILLCREST
FACILITY NUMBER: 079200235
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2025
Section Cited
CCR
80072(a)(3)
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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions…
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Deficiency corrected during visit.

ADM completed staff in-service retraining on clients' personal rights on 10/03/25 in compliance with Section 80072(a)(3).
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This requirement was not met as evidenced by staff pushing resident which posed a potential health & safety risk to resident in care
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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: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5