079200608-7-24-2025-15-AS-KHOS-DJZNBY-20250728101956

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200608
Report Date: 07/24/2025
Date Signed: 07/24/2025 03:42:58 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
07/18/2025 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20250718090403

FACILITY NAME:	ST CATHERINE HOME		FACILITY NUMBER:	079200608
ADMINISTRATOR:	JO, CHRISTOPHER		FACILITY TYPE:	735
ADDRESS:	1845 BADGER PASS WAY		TELEPHONE:	(925) 577-4150
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 6	DATE:	07/24/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tiffany Graham-Leoncio , Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff yells at resident

INVESTIGATION FINDINGS:

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On 07/24/25 at 1PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with Administrator (ED/ADM). LPA explained the purpose of the visit with ADM. LPA conducted interviews & record reviews and delivered investigation findings to ADM.

During investigation, LPA interviewed reporting party (RP), staff (ADM, S1, S2), residents (R1, R2, R3, R4) and obtained the following documents from ADM: Personnel Record (LIC500), Client roster(LIC9020), Designation of facility responsibility (LIC308), 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: 07/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

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-20250718090403

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: ST CATHERINE HOME	FACILITY NUMBER: 079200608
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/11/2025 Section Cited CCR 80072(a)(1)	1 2 3 4 5 6 7	To be accorded dignity in his/her personal relationships with staff and other persons.	1 2 3 4 5 6 7	By POC due date, ADM agrees to complete and submit to CCL completed in-service staff re-trainings on proper re-direction of aggressive clients and clients’ personal rights certified by a CCLD approved vendor in compliance with Section 80072(a)(1).
	8 9 10 11 12 13 14	This requirement was not met as evidenced by staff yelling at resident which posed a potential health and safety risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 07/24/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

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
07/18/2025 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20250718090403

FACILITY NAME:	ST CATHERINE HOME		FACILITY NUMBER:	079200608
ADMINISTRATOR:	JO, CHRISTOPHER		FACILITY TYPE:	735
ADDRESS:	1845 BADGER PASS WAY		TELEPHONE:	(925) 577-4150
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 6	DATE:	07/24/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tiffany Graham-Leoncio , Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff discriminating against resident
Staff does not provide a comfortable environment for resident

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

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-20250718090403

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: ST CATHERINE HOME	FACILITY NUMBER: 079200608
	VISIT DATE: 07/24/2025

NARRATIVE

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Allegation: Staff discriminating against resident
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with staff (ADM, S1, S2), RCEB case manager (W1), reporting party (RP) and other residents (C2,C3, C4). RP stated he was discriminated against by staff (S1) because of his disability and race. Staff (ADM, S1, S2) denied discriminating against RP or any resident. C2, C3 and C4 confirmed with LPA that staff treat them well, are nice to them and do not discriminate against them. W1 also stated she has never observed any resident being discriminated against by staff on her routine visits at the facility for over a year. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff is discriminating against resident is unsubstantiated.

Allegation: Staff does not provide a comfortable environment for resident
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with staff (ADM, S1, S2), RCEB case manager (W1), reporting party (RP) and other residents (C2, C3, C4). RP stated he feels discriminated against by staff due to his race and does not trust staff preparing his food Staff (ADM, S1, S2) denied discriminating against RP or other residents. Other residents (C2, C3, C4) confirmed with LPA that staff do not discriminate against them and treat them well. They like living at the facility and are comfortable with staff providing them their daily needs. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff is discriminating against 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: 07/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 15-AS-20250718090403

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: ST CATHERINE HOME	FACILITY NUMBER: 079200608
	VISIT DATE: 07/24/2025

NARRATIVE

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Allegation: Staff yells at resident
Investigation Finding: Substantiated
During investigation, LPA interviewed staff (ADM, S1, S2) and reporting party (RP) who confirmed that on 07/17/25 at around 2:30PM, S1 engaged in a heated argument with client (C1) over the lunch meal thrown in the garbage on 07/15/25 and 07/16/25. The heated exchange agitated C1 who started yelling and cursing at S1 who yelled back at C1 in defense. S2 stated she was on duty that day when both S1 and C1 yelled at each other. S2 stated that C1 continued to yell and curse at S1 after she left the kitchen/dining room area. Based on LPA’s interviews and record reviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) that staff yells at 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: 07/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 5