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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201340
Report Date: 07/07/2026
Date Signed: 07/07/2026 02:00:48 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
04/06/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260406124015
FACILITY NAME:ESTHER ANGELS CARE HOMEFACILITY NUMBER:
079201340
ADMINISTRATOR:ACHOLONU, ROSE C.FACILITY TYPE:
740
ADDRESS:1403 PREWETT RANCH DR.TELEPHONE:
(500) 435-8093
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:6CENSUS: 6DATE:
07/07/2026
UNANNOUNCEDTIME BEGAN:
01:54 PM
MET WITH:Rita Ogbemure, Staff
Rose Acholonu, Administrator
TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff mismanage resident's medication
Staff do not keep facility clean and sanitary
INVESTIGATION FINDINGS:
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On07/07/26 at 1PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent visit with staff (S1) and spoke to administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the report. LPA explained the purpose of the visit with staff (ADM, S1).

During investigation, LPA interviewed staff (ADM, S1) and obtained the following documents: Personnel record (LIC500), Resident roster, pre-appraisal report, Admission agreement, physician's report, Needs/Services plan, ID/Emergency information, Medication administration records (MARs), After Discharge visit report, 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: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
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-20260406124015
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: ESTHER ANGELS CARE HOME
FACILITY NUMBER: 079201340
VISIT DATE: 07/07/2026
NARRATIVE
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Allegation: Staff mismanaged resident’s medication
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP), residents (R1) responsible party (POA), facility staff (ADM, S1) and reviewed resident (R1) documents. Review of R1’s medication administration records from 02/22/26 until 03/01/26 showed staff administered R1’s medications as prescribed by his primary care physician. Staff (ADM, S1) stated they recorded R1’s medication administration daily and that POA praised them for taking good care of R1. 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 mismanaged resident’s medication was found to be unsubstantiated.

Allegation: Staff do not keep facility clean and sanitary
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with reporting party (RP), residents (R2, R3), responsible party (POA), facility staff (ADM, S1) and reviewed resident (R1) documents. LPA interviewed residents (R2, R3) who confirmed that staff cleans and sanitizes their bedrooms, bathrooms and common areas daily. Prior unannounced visits by LPA on 03/17/26 and 04/07/26 showed residents’ bathrooms were observed clean and odor free. 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 do not keep facility clean and sanitary 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: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
LIC9099 (FAS) - (06/04)
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