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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201150
Report Date: 10/23/2025
Date Signed: 10/23/2025 03:43:43 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
08/15/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250815101145
FACILITY NAME:CONNECTED LIVING ANTIOCH IIFACILITY NUMBER:
079201150
ADMINISTRATOR:TRAIL, SARAFACILITY TYPE:
735
ADDRESS:2350 GALLOWAY 1/2 CTTELEPHONE:
(925) 826-6830
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:2CENSUS: 1DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rosa Torres, Staff
Kay Trail, Administrator		TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff member spoke inappropriately to resident in care
INVESTIGATION FINDINGS:
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On 10/23/25 at 2:30PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit, met with staff (S1) and spoke to administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with staff (ADM, S1). LPA delivered investigation findings to S1, ADM.

During investigation, LPA obtained the following documents from administrator – Personnel record, Clients’ roster, admission agreement, physician’s report, IS/IPP plans, quarter 3 review, 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: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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 6
Control Number 15-AS-20250815101145
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: CONNECTED LIVING ANTIOCH II
FACILITY NUMBER: 079201150
VISIT DATE: 10/23/2025
NARRATIVE
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Allegation: Staff member spoke inappropriately to resident in care
Finding: Substantiated
During investigation, LPA interviewed reporting party (RP), staff (ADM, S1), RCEB case manager, therapist (BH) and reviewed resident’s (R1) documents. Review of incident report (SIR) dated 07/07/25 showed staff (S3) made an inappropriate comment to R1 saying “You have a nice butt”. Based on interviews and observations which were conducted, the preponderance of evidence standard has been met and the above allegation(s) that staff member spoke inappropriately to resident in care is 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: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 15-AS-20250815101145
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: CONNECTED LIVING ANTIOCH II
FACILITY NUMBER: 079201150
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2025
Section Cited
CCR
80072(a)(1)
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To be accorded dignity in his/her personal relationships with staff and other persons
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By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on residents’ personal rights in compliance with Section 80072(a)(1).
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This requirement was not met as evidenced by a staff member’s inappropriate comment to resident in care which posed a potential health and safety risk to resident 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: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
08/15/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250815101145

FACILITY NAME:CONNECTED LIVING ANTIOCH IIFACILITY NUMBER:
079201150
ADMINISTRATOR:TRAIL, SARAFACILITY TYPE:
735
ADDRESS:2350 GALLOWAY 1/2 CTTELEPHONE:
(925) 826-6830
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:2CENSUS: 1DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rosa Torres, Staff
Kay Trail, Administrator		TIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
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9
Staff yell at resident in care
Staff do not accord privacy to resident in care
Staff threaten resident in care
Staff retaliated against resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
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13
On 10/23/25 at 2:30PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit, met with staff (S1) and spoke to administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with staff (ADM, S1). LPA delivered investigation findings to S1, ADM.

During investigation, LPA obtained the following documents from administrator – Personnel record, Clients’ roster, admission agreement, physician’s report, IS/IPP plans, quarter 3 review, incident reports.

Continued on next page, LIC 9099-C pg2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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 6
Control Number 15-AS-20250815101145
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: CONNECTED LIVING ANTIOCH II
FACILITY NUMBER: 079201150
VISIT DATE: 10/23/2025
NARRATIVE
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Allegation: Staff yell at resident in care
Finding: Unsubstantiated
During investigation, LPA interviewed staff (ADM, S1) who stated that resident (R1) has a long history of falsely accusing others when she is angry and then denies making the accusations. RCEB case manager (CM) stated that due to the negative relationship between R1 and staff, they constantly have arguments. CM stated she did not observe staff yell at R1 during her quarterly and annual visits at the facility. Staff also denied yelling at R1. 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 yell at resident in care was found to be unsubstantiated.

Allegation: Staff do not accord privacy to resident in care
Finding: Unsubstantiated
During investigation. LPA interviewed reporting party (RP), staff (ADM, S4), RCEB case manager, therapist (BH) and reviewed resident’s documents. Review of R1’s progress notes dated 08/07/25 showed that on 08/12/25 R1 was very rude with the behavior consultant and staff (S4) during a scheduled meeting. R1 told them she has had enough of these meetings, left abruptly, locked herself inside her bedroom and called her therapist claiming she was being harassed. ADM stated she knocked on R1’s door, unlocked it and convinced her to return to the meeting with the behavior consultant. 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 accord privacy to resident in care was found to be unsubstantiated.

Allegation: Staff threaten resident in care
Finding: Unsubstantiated
During investigation, LPA interviewed staff (ADM, S1, S4), RCEB case manager (CM) and reviewed resident’s (R1) documents. Staff (ADM, S1, S4) denied threatening R1 with a 51/50 hold. RCEB case manager stated she did not observe staff threaten R1 during her quarterly and annual unannounced visits since April 2024. LPA also did not observe staff threaten R1 during visits on 02/05/25 and 08/18/25. 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 threaten resident in care was found to be unsubstantiated. Continued on next page, LIC 9099-C pg3
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 15-AS-20250815101145
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: CONNECTED LIVING ANTIOCH II
FACILITY NUMBER: 079201150
VISIT DATE: 10/23/2025
NARRATIVE
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Allegation: Staff retaliated against resident in care
Finding: Unsubstantiated
During investigation, LPA interviewed staff (ADM, S1, S4), RCEB case manager (CM) and reviewed resident’s (R1) documents. Staff denied retaliating against R1. ADM stated that R1 would retaliate against them by calling her therapist reporting that she is being harassed by staff. RCEB CM stated that she did not observe staff retaliate against R1 on her unannounced quarterly and annual visits from April 2024 until 08/31/25. LPA also did not observe staff retaliate against R1 during visits on 02/05/25 and 08/18/25 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 retaliated against resident in care was found to be unsubstantiated.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6