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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201340
Report Date: 07/07/2026
Date Signed: 07/14/2026 11:06:48 AM

Substantiated


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
04/24/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260424094153
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:
02:03 PM
MET WITH:Rita Ogbemure, Staff
Rose Acholonu, Administrator		TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff are not communicating with hospital personnel as necessary.
INVESTIGATION FINDINGS:
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On 07/14/26 at 11AM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM). LPA explained the purpose of the visit with ADM. This is an AMENDMENT of original complaint report dated 04/24/26.

On 05/04/26, 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
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026
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 3
Control Number 15-AS-20260424094153
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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This is an AMENDMENT of original complaint report dated 04/24/26.

Allegation: Staff are not communicating with hospital personnel as necessary
Investigation Finding: Substantiated
During investigation, LPA conducted interviews with reporting party (RP), facility staff (ADM) and reviewed resident (R1) documents. ADM stated R1 was sent to the hospital on 04/22/26 for back pain. After treatment, ER staff tried to contact facility staff to coordinate the discharge plan for R1 and were unable to reach or receive any responses from staff for over 41 hours. On 04/24/26, ADM admitted with LPA that she refused to take R1 back from the hospital even though she received voicemail messages from hospital staff that R1 was ready for discharge. Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation(s) that facility staff are not communicating with hospital personnel as necessary was found to be substantiated.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20260424094153
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2026
Section Cited
CCR
87468.1(a)(9)
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To have communications to the licensee from their representatives answered promptly and appropriately.
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This is an AMENDMENT to original plan of correction issued on 07/07/26.
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This requirement was not met as evidenced by staff not communicating with hospital personnel as necessary, which posed a potential health and safety risk to resident in care.
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By POC due date, ADM agrees to complete and submit to CCL in-service staff retraining on accepting returning residents back from hospitalization in compliance with Section 87468.1(a)(9) regulation.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3