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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201299
Report Date: 06/04/2025
Date Signed: 06/04/2025 04:06:20 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
05/30/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250530162704
FACILITY NAME:STERLING ESTATES, LLCFACILITY NUMBER:
079201299
ADMINISTRATOR:VALERIE SERGEYFACILITY TYPE:
740
ADDRESS:5208 JUDSONVILLE DRIVETELEPHONE:
(925) 808-9778
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 4DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Valerie Sergey, AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff yells at resident
INVESTIGATION FINDINGS:
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On 06/04/25 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information and delivered investigation findings of above allegations. LPA explained the purpose of the visit with ADM.

During investigation, the department obtained the following documents from ADM - staff roster, residents’ roster, admission agreement, physicians report, Needs & Services plan, Centrally stored medication logs, medication administration records and incident reports.

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

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
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 2
Control Number 15-AS-20250530162704
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: STERLING ESTATES, LLC
FACILITY NUMBER: 079201299
VISIT DATE: 06/04/2025
NARRATIVE
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Allegation: Staff yells at resident
Investigation Finding: Unsubstantiated
During investigation, LPA interviewed reporting party (RP), residents (R1, R2, R3, R4) staff (ADM, S1) and reviewed resident documents. R1 stated that staff do not yell or scream at her. She stated she has no concerns with staff and that they treat her well. Other residents stated that staff do not yell or scream at them and assist them with their daily meals, activities and medications. They also stated that they have no issues with staff. Staff (ADM, S1) denied yelling at any resident while in care. During visit, LPA observed residents (R1, R2, R3 & R4) comfortable in their surroundings with staff assisting them with their activities of daily living (toileting, meals, transferring from wheelchair/walker to couch or bed). 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 yells at resident is unsubstantiated.

No deficiency cited. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2