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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200575
Report Date: 08/04/2026
Date Signed: 08/04/2026 04:18:37 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
05/18/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260518092723
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: 105DATE:
08/04/2026
UNANNOUNCEDTIME BEGAN:
12:26 PM
MET WITH:Heather Montgomery, Executive DirectorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility staff do not ensure residents are served food of good quality
INVESTIGATION FINDINGS:
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On 08/04/26 at 2PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with ED/Administrator (ED/ADM). LPA explained the purpose of the visit with ED.

During investigation, LPA interviewed staff (ED, Kitchen Chef) and random residents (R1, R2, R3), toured the kitchen area and obtained the following documents: Personnel record (LIC500), Residents' roster, Kitchen maintenance records.

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: 08/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
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-20260518092723
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: 08/04/2026
NARRATIVE
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Allegation: Facility staff do not ensure residents are served food of good quality.
Investigation Finding: Unsubstantiated
During investigation, LPA interviewed reporting party (RP), staff (ADM, Kitchen Chef (KC)) and toured the kitchen and common dining areas. RP stated that she observed the soup was below lukewarm on 05/12/26 and that the coleslaw salad and dressing served on 05/15/26 during lunch were warm instead of cold. On 05/27/26. LPA toured the kitchen area and observed small fresh salad small bowls with plastic covers stored inside the refrigerator with thermostat reading at 40 deg F. KC stated fresh salads are always stored in the refrigerator until service starts for lunch/dinner and are not left sitting on the kitchen counter for long periods of time. LPA also observed that soups were cooked and stored hot in large pots with thermostat measured temperatures at 190 deg F. On 05/27/26 at 3PM, LPA interviewed random residents (R1, R2, R3) who stated they were satisfied with the quantity and quality of food served at the facility – soups were served hot and salads were served cold. ED stated she did not receive any complaints from residents or visitors regarding the quantity or quality of food served during meals at the facility. KC stated she regularly holds monthly food meetings at the end of each month with residents and did not receive any food complaints from residents (05/29/26, 06/26/26, 07/31/26). 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 facility staff do not ensure residents are served food of good quality was found to be unsubstantiated.

No deficiency cited during visit.

Exit interview and a copy of this report provided.

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

DATE: 08/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2