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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 05:42:08 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
01/29/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260129080923
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:
05:00 PM
MET WITH:Jenna Asuncion, Administrator
Ann Jennifer Coching, Staff		TIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff do not ensure residents’ living quarters are clean and sanitary
Staff do not wash hands after handling mice feces
INVESTIGATION FINDINGS:
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On 04/29/26 at 4PM, 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.

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 5
Control Number 15-AS-20260129080923
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 do not ensure residents’ living quarters are clean and sanitary
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 inspected the facility and observed the presence of a dead cockroach in Rm#1 and presence of rodent droppings in Rm#2. RP shared photos of rodent droppings in resident’s (R1) drawers, clothes, closet and personal hygiene items at the facility dated 1/26/26. 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 do not ensure residents’ living quarters are clean and sanitary was found to be substantiated.

Allegation: Staff do not wash hands after handling mice feces
Investigation Finding: Substantiated
During investigation, the Department conducted interviews of facility staff & responsible party (POA) and reviewed resident (R1) documents. POA stated that on 01/27/26, she observed staff tried to give R1 his medication and clean the open wound on his right ear without washing their hands after cleaning the closet contaminated with mice feces. Staff (S2) confirmed with LPA that they did not wash their hands when they tried to apply the medication on R1’s open wound. 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 do not wash hands after handling mice feces 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: 2 of 5
Control Number 15-AS-20260129080923
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
04/29/2026
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Deficiency corrected during visit.

ADM hired a professional exterminator company on 01/28/26 and resolved vermin infestation. Staff also cleaned and sanitized all bedrooms, bathrooms, kitchen, dining and common areas on 01/28/26.
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This requirement was not met as evidenced by staff did not ensure residents’ living quarters are clean and sanitary which posed a potential health and safety risk to resident in care.
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Type B
05/27/2026
Section Cited
CCR
87470(a)(1)(A)
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All staff and volunteers shall perform hand hygiene. (A) Hand hygiene shall include hand washing with soap and water or using an alcohol-based sanitizer or any other sanitizing method recommended by a medical professional, local health official, health department, or other research-based medical authority.
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By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on infection control requirements in compliance with Section 87470 regulations.
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This requirement was not met as evidenced by staff did not wash hands after handling mice feces which posed a potential health & 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: 3 of 5
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
01/29/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260129080923

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:
05:00 PM
MET WITH:Jenna Asuncion, Administrator
Ann Jennifer Coching, Staff		TIME COMPLETED:
06:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handled resident in a rough manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/29/26 at 4PM, 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.

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 5
Control Number 15-AS-20260129080923
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 handled resident in a rough manner
Investigation Finding: Unsubstantiated
During investigation, the Department conducted interviews of facility staff (ADM, S1), R2’s responsible party (POA) and reviewed R2’s documents. RP stated that she witnessed staff handle R2 in a rough manner when placing him in his bed or on his chair. Review of R2’s admission agreement showed he was first admitted at the facility on 09/30/23. Staff denied handling R2 in a rough manner and stated that they assisted R2 with his activities of daily living such as bathing, toileting, diaper changes, dressing, grooming, transfer to and from the bed, meals and medications. On 01/30/26, POA confirmed with LPA that staff provided R2 with proper care and supervision while residing at the facility. 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 handled resident in a rough manner was found to be 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 5