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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200575
Report Date: 11/18/2025
Date Signed: 11/18/2025 04:35:23 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
09/09/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250909132100
FACILITY NAME:COMMONS AT DALLAS RANCH, THEFACILITY NUMBER:
079200575
ADMINISTRATOR:RFACILITY TYPE:
740
ADDRESS:4751 DALLAS RANCH ROADTELEPHONE:
(925) 754-7772
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:123CENSUS: 107DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Francine Taitano, AdministratorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff do not respond to resident’s call button in a timely manner
INVESTIGATION FINDINGS:
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On 11/18/25 at 4PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver the findings of above allegations. LPA explained the purpose of the visit with ADM.

During investigation, LPA obtained the following documents from administrator – personnel record, residents’ roster, admission agreements, needs & services plans, physicians’ orders, medication administration records, call logs, 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: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
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-20250909132100
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: COMMONS AT DALLAS RANCH, THE
FACILITY NUMBER: 079200575
VISIT DATE: 11/18/2025
NARRATIVE
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Allegation: Staff do not respond to resident’s call button in a timely manner
Investigation Finding: Substantiated
During investigation, LPA conducted interviews of facility staff (ADM, S1, S2), authorized representative (POA) and reviewed residents’ (R1, R2, R3) documents. On 09/18/25, ADM confirmed with LPA that staff are not timely responding to residents’ calls when they are in the middle of assisting another resident when the call came through. ADM stated they have come up with a plan for staff to communicate with another staff for help so that the resident’s calling will not have to wait a long time for staff to respond. Based on the Department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff did not ensure medication was dispensed as prescribed was found to be substantiated.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted, appeal rights and copy of report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20250909132100
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: COMMONS AT DALLAS RANCH, THE
FACILITY NUMBER: 079200575
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2025
Section Cited
CCR
87468.2(4)
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To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs...
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Deficiency corrected on 09/19/25.

Administrator completed in-service retraining of all staff on timely responding to resident’s call button in compliance with Title 22 Section 87468.2 regulations.
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This requirement was not met as evidenced by staff failing to respond to resident’s call button in a timely manner which posed a potential health & safety risk to residents 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: 11/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 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
09/09/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250909132100

FACILITY NAME:COMMONS AT DALLAS RANCH, THEFACILITY NUMBER:
079200575
ADMINISTRATOR:RFACILITY TYPE:
740
ADDRESS:4751 DALLAS RANCH ROADTELEPHONE:
(925) 754-7772
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:123CENSUS: 107DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Francine Taitano, AdministratorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
Staff are not properly trained to care and supervise residents
Staff do not assist with resident’s basic ADLs
INVESTIGATION FINDINGS:
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On 11/18/25 at 4PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver the findings of above allegations. LPA explained the purpose of the visit with ADM.

During investigation, LPA obtained the following documents from administrator – personnel record, residents’ roster, admission agreements, needs & services plans, physicians’ orders, medication administration records, call logs, incident reports.

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: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250909132100
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: COMMONS AT DALLAS RANCH, THE
FACILITY NUMBER: 079200575
VISIT DATE: 11/18/2025
NARRATIVE
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Allegation: Staff are not properly trained to care and supervise residents
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews of facility staff (ADM, S1, S2), authorized representative (POA) and reviewed staff training records. ADM confirmed with LPA that caregivers have current first aid training certifications but are not CPR certified. ADM stated only one staff per shift is CPR certified. ADM stated they are in the process of having more CPR certifications completed for other staff per shift. Review of staff records showed staff have current first aid certifications and 20 hours required annual on the job training certifications on assisted living and dementia care. On 09/18/25, LPA interviewed S1 who confirmed that on 09/06/25 she was the server on duty in the dining room. S1 stated resident (R2) choked on a piece of pancake when eating breakfast with other residents (R1, R3). R2 managed to clear the piece of pancake in his throat by drinking water given by staff during the breakfast meal. S1 stated R2 did not turn blue during the incident and that R2 was able to clear his throat with the water that he drank. Based on records review, interviews conducted, and observations made, the Department has investigated the above allegation that staff are not properly trained to care and supervise residents and found it to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that 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 are not properly trained to care and supervise residents is unsubstantiated.

Allegation: Staff do not assist with resident’s basic ADLs
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews of facility staff (ADM, S1, S2), authorized representative (POA) and reviewed residents’ (R1, R2, R3) documents. Staff stated they assist each resident’s activities of daily living (ADLs) based on their level of care/ needs and services plans. Review of residents’ (R1, R2, R3) needs and services plans dated 11/22/24, 04/22/25 and 07/18/25 showed staff assist residents with ambulation 5X per day every day, scheduling medical appointments, bathing 1X per day every week, dressing 2X per day every day and status checks 12X per day every day. Based on records review, interviews conducted, and observations made, the Department has investigated the above allegation that staff do not assist with resident’s basic ADLs and found it to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that 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 do not assist with resident’s basic ADLs 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: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5