079200748-1-21-2026-15-AS-BFOG-DQT2Z8-20260129164954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200748
Report Date: 01/21/2026
Date Signed: 01/21/2026 04:25:21 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
01/08/2026 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20260108151520

FACILITY NAME:	TREVISTA ANTIOCH		FACILITY NUMBER:	079200748
ADMINISTRATOR:	ALBERTO MALDONADO		FACILITY TYPE:	740
ADDRESS:	3950 LONE TREE WAY		TELEPHONE:	(925) 470-3395
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	131	CENSUS: 115	DATE:	01/21/2026
		UNANNOUNCED	TIME BEGAN:	03:58 PM
MET WITH:	Teresa Glenn, Manager on Duty Erika Mendez, Wellness Director		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not accord resident privacy

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 01/21/26 3:58PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit, met with Manager on Duty (MOD) and delivered investigation finding. LPA explained the purpose of the visit with MOD.

On 01/14/26, LPA obtained the following documents from manager on duty (MOD): Personnel record (LIC500), Residents roster, Fall detection system (Sage Motion Detectors) notification to residents and responsible parties dated 12/12/25.

Continued on next page, LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

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-20260108151520

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: TREVISTA ANTIOCH	FACILITY NUMBER: 079200748
	VISIT DATE: 01/21/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff do not accord resident privacy
Investigation Finding: Unsubstantiated
During investigation LPA interviewed reporting party (RP), staff (Manager on Duty (MOD, Regional Director (RD) and reviewed the Sage Fall Detection System notification letter sent to residents on 12/12/25. RP stated that the facility has installed AI fall cameras in all resident bedrooms including memory care (sign notification on the door walking into memory care) which are capable of fall detection and motion/video recording. On 01/14/26 at 3:30PM, LPA toured the facility and observed the motion detector devices installed inside assisted living and memory care residents’ bedrooms. RD stated that the Sage Motion Detectors are not surveillance cameras. They are motion detectors which do not record any audio or continuous live monitoring. RD stated that the facility will hold informational meetings about the Sage motion detection system for additional education, understanding of the system and consent forms will be provided to all residents, authorized representatives, family members who would like to avail of the fall detention system service. MOD stated residents who decide not ot avail of the Sage fall detection system will have the device covered and inactive from the system. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff do not accord resident privacy is unsubstantiated.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2