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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200250
Report Date: 10/14/2025
Date Signed: 10/14/2025 05:02:35 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
10/13/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20251013115205
FACILITY NAME:RIDGELINE HOMEFACILITY NUMBER:
079200250
ADMINISTRATOR:ALEXIS A ANCHETAFACILITY TYPE:
735
ADDRESS:4646 RIDGELINE DRIVETELEPHONE:
(925) 303-2406
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 6DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Lucky Thammalangsy, AdministratorTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Staff did not seek medical attention to resident
Administrator does not ensure facility has a substitute administrator when not present in home
INVESTIGATION FINDINGS:
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On 10/14/25 at 3:15PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced 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 staff (ADM, S1), client (C1), ADP Program Director and obtained the following documents from administrator – Personnel record (LIC500), Clients' roster, admission agreement, physician’s report, needs & services plan,ISP/IPP plan, After Visit Discharge report, incident reports.

Continued on next page, LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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-20251013115205
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: RIDGELINE HOME
FACILITY NUMBER: 079200250
VISIT DATE: 10/14/2025
NARRATIVE
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Allegation: Staff did not seek medical attention to resident
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with staff (ADM, S1), ADP Director (AD) and reviewed client's (C1) documents. ADM stated that on 10/09/25 at around 1:10PM, Adult Day Program reported that C1 sustained injuries on her lip/right side of her face when she accidentally tripped on a manhole and fell face down on the side walk on her way to the transport vehicle. C1 suffered lacerations on her upper lip and right cheek. ADP staff immediately treated C1 with first aid and sent her to the hospital for evaluation and treatment. C1 received stitches on her lip and was discharged the same day with facility staff assisting her back.to the facility. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff did not seek medical attention to resident is unsubstantiated.

Allegation: Administrator does not ensure facility has a substitute administrator when not present in home
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with staff (ADM, S1) and reviewed client's (C1) documents. ADM confirmed with LPA that he works at the facility Monday to Friday from 9AM until 2PM. S1 stated that she is the designated manager on duty whenever ADM is not available at the facility. LPA reviewed the designation of facility responsibility (LIC 308) dated 10/14/24 which showed S1 as the authorized manager on duty. LPA observed ADM was present during unannounced visits dated 05/02/24 and 06/20/25. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that administrator does not ensure facility has a substitute administrator when not present in home 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: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2