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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200582
Report Date: 08/03/2026
Date Signed: 08/03/2026 04:22:04 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
07/31/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260731155414
FACILITY NAME:AMBASSADOR CARE HOMEFACILITY NUMBER:
079200582
ADMINISTRATOR:IKHARO-UMARU, RAUFATFACILITY TYPE:
740
ADDRESS:145 BEEDE WAYTELEPHONE:
(510) 812-2188
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: 4DATE:
08/03/2026
UNANNOUNCEDTIME BEGAN:
03:49 PM
MET WITH:Raufat Ikharo-Umaru, AdministratorTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Staff neglect and lack of supervision of residents
INVESTIGATION FINDINGS:
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On 08/03/26 at 3:51PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with staff (ADM) gathered information on the allegation and delivered investigation finding to ADM. LPA explained the purpose of the visit with staff (ADM, S1) during visit.

Allegation: Staff neglect and lack of supervision
Investigation Finding: Substantiated
On 08/03/26 at 3:51PM, LPA interviewed reporting party (RP) and staff (ADM) regarding the allegation of staff neglect and lack of supervision. ADM stated that on 07/21/26, staff (S2) was under the influence of alcohol while on duty and called 911 because she was experiencing abdominal pain. Contra Costa Fire Department responded to the 911 call and Emergency personnel found S2 to be intoxicated, exhibiting a strong odor of alcohol. RP stated that three (3) residents under her care on that day were found foraging for food.

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: 08/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2026
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 3
Control Number 15-AS-20260731155414
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: AMBASSADOR CARE HOME
FACILITY NUMBER: 079200582
VISIT DATE: 08/03/2026
NARRATIVE
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Antioch Police called ADM to take over the care of the residents while S2 was taken to the hospital for treatment and evaluation. RP stated ADM arrived at the facility 20 minutes after the initial call. ADM stated S2 was terminated immediately after discharge from the hospital. Based on LPA’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) was found to be substantiated.

Immediate civil penalty of $500 assessed during visit for immediate health and safety risk to residents.

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: 08/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20260731155414
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: AMBASSADOR CARE HOME
FACILITY NUMBER: 079200582
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/03/2026
Section Cited
CCR
87468.2(a)(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 was corrected on 07/21/26 by ADM terminating S2’s employment after discharge from the hospital the same day.

Immediate civil penalty of $500 assessed during visit.
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This requirement was not met as evidenced by staff working under the influence of alcohol which posed an immediate health and 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.
SUPERVISOR'S NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3