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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201256
Report Date: 04/29/2026
Date Signed: 04/29/2026 05:03:35 PM

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
01/28/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260128102015
FACILITY NAME:A LOVING HOMEFACILITY NUMBER:
079201256
ADMINISTRATOR:ALOOT, DONNIEFACILITY TYPE:
740
ADDRESS:3420 CLAYBURN RD.TELEPHONE:
(951) 522-1228
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: 3DATE:
04/29/2026
UNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Jenna Asuncion, Administrator
Maria Matel, Staff		TIME COMPLETED:
05:10 PM
ALLEGATION(S):
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Staff did not prevent a resident from developing pressure injuries while in care
Staff did not administer medication as prescribed
Staff did not clean resident’s bedding
Staff did not keep facility clear of vermin
INVESTIGATION FINDINGS:
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On 04/29/26 at 4:10PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver the findings of above allegations. LPA explained the purpose of the visit with ADM.

During investigation, LPA obtained the following documents from administrator – Personnel record (LIC500), Residents roster, Admission agreements, Physician’s reports, Needs & Services plans, Hospice care plan, Centrally stored medication logs, After visit discharge reports, incident reports. Health & safety check conducted on 01/28/26 (see LIC 809 dated 01/28/26).

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: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
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 7
Control Number 15-AS-20260128102015
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: A LOVING HOME
FACILITY NUMBER: 079201256
VISIT DATE: 04/29/2026
NARRATIVE
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Allegation: Staff did not prevent a resident from developing pressure injuries while in care
Investigation Finding: Substantiated
During investigation, the Department conducted interviews of facility staff (ADM, S1, S2) & R1’s responsible party (POA), witness (W1) and reviewed resident (R1) documents. Review of R1’s admission agreement showed he was first admitted at the facility on 06/16/23 and resided at the facility until 01/28/26. R1 was assessed with mild cognitive impairment, non-ambulatory, needs assistance transferring in & out of bed and did not have a history of skin breakdown as shown on R1’s physician’s report dated 06/07/23. On 01/15/26, R1 was admitted into hospice care and diagnosed with a total of 5 pressure injuries on his back (three stage 2 pressure injuries), left buttock (one stage 2 pressure injury) and sacrum (one stage 3 pressure injury) and a tumor wound. On 01/27/26, responsible party (POA) removed R1 from the facility due to unsanitary conditions. W1 visited R1 at POA’s home and observed five pressure injuries on R1. Based on the Department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff did not prevent a resident from developing pressure injuries while in care was found to be substantiated.

Immediate civil penalty of $500 assessed during visit for staff failing to prevent resident from developing multiple pressure injuries while in care. Additional civil penalty related to serious bodily injury is pending review.

Allegation: Staff did not administer medication as prescribed


Investigation Finding: Substantiated
During investigation, the Department conducted interviews of facility staff & responsible parties and reviewed resident (R1) documents. Staff confirmed with LPA that they were giving a topical medication orally to R1 by placing the powder inside water and giving it for him to drink until hospice nurse pointed out this error. Review of R1’s hospice care orders dated 01/20/26 showed topical powder was to be applied to R1’s right ear tumor wound 2X per week. Based on the Department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff did not administer medications as prescribed was found to be substantiated.

Continued on next page, LIC 9099-C pg 1
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 15-AS-20260128102015
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: A LOVING HOME
FACILITY NUMBER: 079201256
VISIT DATE: 04/29/2026
NARRATIVE
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Allegation: Staff did not clean resident’s bedding
Investigation Finding: Substantiated
During investigation, the Department conducted interviews of facility staff & responsible parties and reviewed resident (R1) documents. POA stated during her visits at the facility that R1’s neck pillow was caked with drainage from R1’s right ear and had a strong odor. POA also stated that the pillow was not being washed and family was not notified of need for more pillows to allow washing between uses. Staff (S1, S2) confirmed with LPA that they did not wash the neck pillow used to support R1’ infected ear while in care. Based on the Department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff did not clean resident’s bedding was found to be substantiated.

Allegation: Staff did not keep facility clear of vermin
Investigation Finding: Substantiated
During investigation, the Department conducted interviews of facility staff & responsible party (POA) and reviewed resident (R1) documents. On 01/28/26, LPAs D Panlilio and K Nguyen observed during visit the presence of rodent droppings in resident’s drawers, clothes, closet and personal hygiene items at the facility. POA stated they left R1’s personal items at the facility when they removed him on 01/26/26 because all his personal belongings were contaminated with vermin droppings. Based on the Department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff did not keep facility clear of vermin was found to be substantiated.

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

Exit interview conducted, appeal rights and copy of report provided.

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

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
01/28/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260128102015

FACILITY NAME:A LOVING HOMEFACILITY NUMBER:
079201256
ADMINISTRATOR:ALOOT, DONNIEFACILITY TYPE:
740
ADDRESS:3420 CLAYBURN RD.TELEPHONE:
(951) 522-1228
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: 3DATE:
04/29/2026
UNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Jenna Asuncion, Administrator
Maria Matel, Staff		TIME COMPLETED:
05:10 PM
ALLEGATION(S):
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Staff left a resident in a soiled diaper for a long period of time
Staff did not maintain a comfortable temperature for a resident in care
Staff left resident in the same clothing for a long period of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/29/26 at 4:10PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver the findings of above allegations. LPA explained the purpose of the visit with ADM.

During investigation, LPA obtained the following documents from administrator – Personnel record (LIC500), Residents roster, Admission agreements, Physician’s reports, Needs & Services plans, Hospice care plan, Centrally stored medication logs, After visit discharge reports, incident reports. Health & safety check conducted on 01/28/26 (see LIC 809 dated 01/28/26).

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: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 15-AS-20260128102015
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: A LOVING HOME
FACILITY NUMBER: 079201256
VISIT DATE: 04/29/2026
NARRATIVE
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Allegation: Staff left a resident in a soiled diaper for a long period of time
Investigation Finding: Unsubstantiated
During investigation, the Department conducted interviews of facility staff (ADM, S1, S2), residents (R2, R3), R1’s responsible party (POA), and reviewed resident (R1) documents. Staff stated that they cleaned and changed all residents’ soiled diapers in the AM before breakfast, checked/changed their diapers as needed before lunch and changed their diapers again before bedtime. S1 stated that he changed R1’s soiled diaper in the AM on 01/20/26. However, R1 had another bowel movement before the hospice nurse arrived in the PM. LPA interviewed other non-ambulatory residents (R2, R3) who stated that staff changed their diapers 3 times a day or as needed. 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 left a resident in a soiled diaper for a long period of time was found to be unsubstantiated.

Allegation: Staff did not maintain a comfortable temperature for a resident in care.
Investigation Finding: Unsubstantiated
During investigation, the Department conducted interviews of facility staff (ADM, S1, S2), responsible parties (POAs) and reviewed resident (R1) documents. RP stated that R1’s bedroom was cold due to staff leaving the window open. During unannounced visits on 06/13/25, 08/12/25 and 01/28/26, LPA inspected the facility and observed residents’ bedrooms, bathrooms, kitchen, dining room and living room areas had a comfortable temperature with thermostat reading at 70 deg F. LPA did not observe any open windows in residents’ bedrooms during visit. 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 maintain a comfortable temperature for a resident in care is unsubstantiated.

Allegation: Staff left resident in the same clothing for a long period of time
Investigation Finding: Unsubstantiated
During investigation, the Department conducted interviews of facility staff (ADM, S1, S2), responsible party (POA) and reviewed resident (R1) documents. RP stated that during multiple visits with R1 at the facility, they observed R1 wearing the same clothes for a long period of time. Staff (S1) stated they assisted R1 with his activities of daily living such as bathing, dressing, grooming and would change his clothes after a bath or if soiled from bowel movements/urination. 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 left resident in the same clothing for a long period of time is unsubstantiated.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 15-AS-20260128102015
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: A LOVING HOME
FACILITY NUMBER: 079201256
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/29/2026
Section Cited
HSC
1569.269
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Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (10) To be free from neglect . . .
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Immediate civil penalty of $500 assessed during visit for staff neglect and supervision which resulted in resident developing five pressure injuries while in care.

Additional civil penalty related to serious bodily injury is pending review.
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This requirement was not met as evidenced by staff failing to provide adequate care & supervision resulting in resident developing multiple pressure injuries which posed an immediate health & safety risk to residents in care
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NCC to be scheduled at a later date.
Type B
05/27/2026
Section Cited
CCR
87633(d)
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The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times
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By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on proper hospice care plan implementation in compliance with Section 87633 regulations.
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This requirement was not met as evidenced by staff not administering medication as prescribed which posed a potential health and safety risk to resident in care.
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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.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 15-AS-20260128102015
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: A LOVING HOME
FACILITY NUMBER: 079201256
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/27/2026
Section Cited
CCR
87468.2(a)(4)
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To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on proper care and supervision of resident in compliance with Section 87468.2 regulations.
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This requirement was not met as evidenced by staff did not clean resident’s bedding which posed a potential health & safety risk to resident in care
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Type B
05/27/2026
Section Cited
CCR
87468.1(2)
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To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on proper care and supervision of resident in compliance with Section 87468.1 regulations.

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This requirement was not met as evidenced by staff did not keep facility clear of vermin which posed a potential health & safety risk to residents in care.
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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.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 7