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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201337
Report Date: 10/09/2025
Date Signed: 10/09/2025 01:14:48 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
09/29/2025 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20250929094324
FACILITY NAME:RODMONHOMES, LLCFACILITY NUMBER:
079201337
ADMINISTRATOR:NUBLA, RODFACILITY TYPE:
735
ADDRESS:5200 PUMA COURTTELEPHONE:
(510) 220-2300
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 6DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Ron Nubla, AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not provide adequate care and supervision
INVESTIGATION FINDINGS:
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On 10/09/25 at 11AM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with staff (ADM), gathered information and delivered investigation findings to ADM. LPA explained the purpose of the visit with ADM.

During investigation, LPA conducted interviews with reporting party (RP), staff (ADM) and obtained the following documents from administrator – Personnel record (LIC500), Clients roster, admission agreement, physician’s report, Needs & services plan, ISP/IPP plans, Psychiatric reports, 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: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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-20250929094324
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: RODMONHOMES, LLC
FACILITY NUMBER: 079201337
VISIT DATE: 10/09/2025
NARRATIVE
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Allegation: Staff did not provide adequate care and supervision
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP), staff (ADM) and reviewed client (C1) documents. ADM stated client (C1) has a 1:1 staff per shift assigned who monitors him at the facility 24/7. Review of C1’s progress notes dated 01/20/25 until 09/12/25 showed C1 engaged in serious injury behaviors (SIBs) mostly at the special needs school that he attends Monday to Friday from 7:30AM until 3:30PM. ADM stated C1 has increased serious injury behaviors (SIBs) since 09/12/25 and would hit his head without warning against a wall giving no time for the staff monitoring to prevent him from hitting his head against the wall. ADM stated that he has discussed C1’s serious injury behaviors with the Special Needs school Program Director, RCEB case manager, in-house Therapist and Psychiatrist . ADM stated they are working towards developing a care plan for C1 that would minimize his serious injury behaviors. ADM also stated he has scheduled a clinical team meeting with RCEB case manager to address C1’s SIBs and start using a padded cushion for 1:1 staff to use when monitoring C1. 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 did not provide adequate care and supervision is unsubstantiated.

No deficiencies 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: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2