079201337-5-27-2026-15-AS-BFOG-DV4TRW-20260616145814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201337
Report Date: 05/27/2026
Date Signed: 05/27/2026 01:51:14 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
04/07/2026 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20260407140303

FACILITY NAME:	RODMONHOMES, LLC		FACILITY NUMBER:	079201337
ADMINISTRATOR:	NUBLA, ROD		FACILITY TYPE:	735
ADDRESS:	5200 PUMA COURT		TELEPHONE:	(510) 220-2300
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 6	DATE:	05/27/2026
		UNANNOUNCED	TIME BEGAN:	01:37 PM
MET WITH:	Rod Nubla, Administrator		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff did not prevent client from physically abusing other client in care resulting in an injury.

INVESTIGATION FINDINGS:

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On 05/27/26 at 2PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit and met with administrator (ADM). LPA explained the purpose of the visit with ADM.

During investigation, LPA conducted interviews with reporting party (RP), staff (ADM, S1) and obtained the following documents from ADM – Personnel record (LIC500), Clients roster, Admission agreements, ID & Emergency information, Physician’s reports, Needs & Services plans, ISP/IPP plans, 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: 05/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026

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-20260407140303

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: 05/27/2026

NARRATIVE

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Allegation: Staff did not prevent client from physically abusing another client in care resulting in injury
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP), facility staff (ADM, S1) and reviewed client’s (C1) documents. ADM stated that on 04/07/26 at 4AM, C1 unexpectedly displayed aggressive behavior towards his roommate (C2). Review of incident reports submitted on 04/07/26 showed C1 bit C2 on the head at 4AM. Staff immediately addressed the incident, treated C2 with first aid and redirected both clients. Staff stated they increased monitoring of C1 to prevent him from biting another client.
ADM stated he notified responsible parties including Adult Day Program staff to closely monitor C1 for behavioral expressions. ADM also stated he has scheduled C1 to see his primary care physician (PCP) and behaviorist to address his change in condition. C1 was also relocated to another bedroom with another roommate. ADM stated night staff checks on C1 every hour to ensure he does not display any aggressive behaviors towards other clients. 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 did not prevent client from physically abusing another client in care resulting in injury was found to be 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: 05/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026

LIC9099 (FAS) - (06/04)

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