079201246-2-13-2026-15-AS-BFOG-DRE4SC-20260217182120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201246
Report Date: 02/03/2026
Date Signed: 02/13/2026 04:47:17 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
01/30/2026 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20260130153429

FACILITY NAME:	CONTRA LOMA HOME LLC		FACILITY NUMBER:	079201246
ADMINISTRATOR:	KUMAR, HARMESH		FACILITY TYPE:	735
ADDRESS:	4131 SHELTER COVE COURT		TELEPHONE:	(925) 826-6557
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 1	DATE:	02/03/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Lu Li, LIcensee Brigida Moredo, Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Licensee allowed uncleared adult to provide care and supervision to residents in care
Licensee did not ensure that staff were adequately trained

INVESTIGATION FINDINGS:

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On 02/13/26 4:30PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit to amend the investigation findings delivered on 02/03/26. LPA obtained the original complaint investigation findings delivered on 02/03/26 from ADM during visit. LPA explained the purpose of the visit with administrator (ADM) and delivered new investigation findings.

During investigation, LPA interviewed licensee (LC) and obtained the following documents from administrator (ADM3): Personnel record (LIC500), Resident roster, staff 20 hours continuous education certifications, Direct Service Professional DSP1 & DSP2 training certifications, administrator certificates (ADM1, ADM2, ADM3), employment history. LPA also generated current employee roster from Guardian Portal which showed all staff fingerprint cleared and associated to the facility.

Continued on next page, LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260130153429

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: CONTRA LOMA HOME LLC	FACILITY NUMBER: 079201246
	VISIT DATE: 02/03/2026

NARRATIVE

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On 02/13/26 4:30PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit to amend the investigation findings delivered on 02/03/26. LPA obtained the original complaint investigation findings delivered on 02/03/26 from ADM during visit. LPA explained the purpose of the visit with administrator (ADM) and delivered new investigation findings.

Allegation: Licensee allowed uncleared adult to provide care and supervision to residents in care
Investigation Finding: Unsubstantiated
During investigation LPA interviewed licensee (LC), staff (ADM1, ADM2, ADM3, S1, S2), client (C1) and reviewed staff documents. Review of employee roster in Guardian Portal dated 01/30/26 showed all staff (ADM1, ADM2, ADM3, S1, S2) were fingerprint cleared and associated to the facility prior to employment. On unannounced visits at the facility on 07/25/25, 08/14/25, 1/23/26 and 01/30/26, LPA observed all staff working at the facility were fingerprint cleared and associated to the facility. 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 is UNSUBSTANTIATED.

Allegation: Licensee did not ensure that staff were adequately trained
Investigation Finding: Unsubstantiated
During investigation LPA interviewed licensee (LC), staff (ADM1, ADM2, ADM3, S1, S2), client (C1) and reviewed staff documents. Review of administrators’ records showed ADM1, ADM2, ADM3 completed their Adult Residential Facility (ARF) Administrator Certification Programs with current Standard Certificates. LPA reviewed documents which showed each staff completed over 20 hours of continuous education, passed the 35-hour Direct Support Professional training classes certifications (DSP1 & DSP2), behavior redirection, documentation, client safety & first aid and crisis management as required by Regional Center of the East Bay (RCEB). 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 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: 02/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026

LIC9099 (FAS) - (06/04)

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