Esther Angels Care Home

Type of visit: Case Management - Other

On 07/14/26 at 11AM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced case management visit regarding an incident that was reported to CCLD on 04/23/26. LPA spoke with staff (S1) and called administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with staff (ADM, S1). R1 was sent to the hospital by facility staff for treatment and evaluation on 04/22/26. R1 was treated for back pain and was ready for discharge back to the facility on the same day. However, ER staff were unable to reach facility staff after several attempts to contact them. On 04/24/26, RP stated she spoke with the Ombudsman and administrator (ADM) who refused to take R1 back to the facility until R1’s responsible party (POA) provided R1’s list of medications and medical insurance card for proper care and supervision. ADM confirmed with LPA that she refused to take back R1 on 04/24/26 until she was provided with R1’s medication list and medical insurance card. LPA reminded ADM that the signed admission agreement between her and R1 is still binding. Therefore, she needs to take back R1 from the hospital. ADM received R1 back at the facility on 04/24/26. Based on LPA’s observations and interviews which were conducted and record reviews, a deficiency is cited for improper eviction under 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.the state’s words, verbatim · CDSS document, Jul 14, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Jul 31, 2026

The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required This requirement was not met as evidenced by staff not communicating with hospital personnel as necessary to accept resident back after hospitalization, which posed a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jul 14, 2026

Plan of correction: By POC due date, ADM agrees to complete and submit to CCL in-service staff retraining on following proper eviction procedures in compliance with Section 872248.1(a) regulation.

Allegation investigated: Staff are not communicating with hospital personnel as necessary.

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 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.the state’s words, verbatim · CDSS document, Jul 7, 2026 · control 15-AS-20260424094153

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(9) · Plan of correction due date: Jul 31, 2026

To have communications to the licensee from their representatives answered promptly and appropriately. 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.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: This is an AMENDMENT to original plan of correction issued on 07/07/26. 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.

Allegation investigated: Staff mismanage resident's medication Staff do not keep facility clean and sanitary

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 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 providedthe state’s words, verbatim · CDSS document, Jul 7, 2026 · control 15-AS-20260406124015

Type of visit: Required - 1 Year

On 03/17/26 at 1PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (S1) and explained the purpose of the visit. LPA spoke with ADM on the phone who authorized S1 to act on her behalf and sign the reports. LPA observed ADM has a current administrator certificate# 6056379740 which expires 09/26/2027. At 1:10PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 76 deg F. Hot water temperature was measured at 113 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Smoke and Carbon monoxide detectors were operational. Fire extinguisher was observed fully charged and last inspected on 01/25/26. LPA reviewed 2 staff and 4 resident files. Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Client Roster  LIC308- Designation of Facility Responsibility  LIC610D- Emergency/Disaster Plan including infection control plans  Evidence of Surety Bond No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 17, 2026

Allegation investigated: Staff left resident in soiled bedding Staff did not ensure resident’s cup was free of mold Staff did not ensure the facility was not in financial distress

On 01/21/26 at 12:30PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit, met with staff (ADM, S1), gathered information and delivered investigation findings to ADM. LPA explained the purpose of the visit with staff. During investigation, LPA conducted interviews with reporting party (RP/DPOA), staff (ADM, S1, S2) and obtained the following documents from ADM – Personnel record (LIC500), Residents roster, admission agreement, physician’s report, needs & services plan, physician's report, medication administration records, blood sugar logs, ID/Emergency information, Progress Notes. Continued on next page, LIC9099-C Substantiated Allegation: Staff left resident in soiled bedding Investigation Finding: Substantiated During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. LPA interviewed RP who shared a photo taken while R1 was residing at the facility showing R1 wearing a soiled diaper with dried brown diarrhea on the side her buttocks as she rested on a soiled bed cover. Based on LPA’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 left resident in soiled bedding was found to be substantiated. Allegation: Staff did not ensure resident’s cup was free of mold Investigation Finding: Substantiated During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) records. LPA analyzed two photos of R1's sippy cup which showed the presence of black mold inside the sipping straw and around the inside rim of R1’s stainless steel tumbler. Based on LPA’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 ensure resident’s cup was free of mold was found to be substantiated. Continued on next page, LIC9099-C pg1 Allegation: Staff did not ensure the facility was not in financial distress Investigation Finding: Substantiated During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. LPA interviewed RP who shared a photo of a water shutoff notice from the City of Antioch given to the facility dated 09/30/25 due to non-payment of service. S1 stated that water was cut off because ADM forgot to pay the water bill. RP also stated that on 11/12/25, the power was shut off by PG&E. S1 stated that ADM forgot to pay the monthly PG&E bill and that they were without power for approximately 10 hours until the bill was paid. Based on LPA’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 ensure the facility was not in financial distress 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 (POCs) 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. Allegation: Staff did not ensure resident had video conference with physician Investigation Finding: Unsubstantiated During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. LPA interviewed ADM who stated that she spoke with RP regarding the missed doctor video chat with R1 on 12/03/25. ADM stated she offered to assist RP and R1 reschedule the video call with her primary care physician. However, ADM stated RP did not follow-up with her again on the rescheduled video call. Review of text messages between RP and S1 in December 2025 showed staff informed RP that the facility phone did not have video chat capability to assist R1 with her scheduled doctor's video chat health evaluation on 12/03/25. Staff (ADM, S1) also stated that they offered to answer any questions during R1’s video chat to assist in R1’s health evaluation. 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 ensure resident had video conference with physician is unsubstantiated. Allegation: Staff did not notice resident’s change in condition Investigation Finding: Unsubstantiated During investigation, LPA conducted interviews with reporting party (RP/DPOA), staff (S1, S2) and reviewed resident (R1) documents. RP stated she visited R1 the past two weeks in December 2025 and observed R1 having belly pain, loss of appetite, unable to sit up, incoherent and weak. RP stated she communicated her concerns about R1’s health condition with staff (ADM, S1, S2) in December 2025. On 12/03/25, ADM stated she spoke with RP and told her that R1 stated she was OK and did not want to see the doctor. ADM stated R1 told the staff she does not want to call the paramedics or 911. LPA interviewed staff (S1) who stated that they did not notice anything wrong with R1 while in care. 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 notice resident’s change in condition is unsubstantiated. Continued on next page, LIC9099-C pg2 Allegation: Staff did not seek medical attention for resident Investigation Finding: Unsubstantiated During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. LPA interviewed RP who stated that she observed R1’s belly was distended for the past two visits. On 12/13/25, RP stated she observed R1 was barely able to tell her that it hurts when she applies pressure on her belly and noticed something was not right. She communicated R1’s concerns with staff (ADM, S1, S2) who offered to call the paramedics or take R1 to see her primary care physician. Staff (ADM, S1) stated that R1 refused to call the paramedics and told them she was fine and feeling well. 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 seek medical attention for resident is unsubstantiated. Allegation: Staff did not ensure they repositioned resident Investigation Finding: Unsubstantiated During investigation, LPA conducted interviews with reporting party (RP/DPOA) staff (S1, S2) and reviewed resident (R1) documents. Review of R1’s physician’s report and needs & services plan dated 07/02/25 did not show presence of any pressure injuries upon admission. Staff (ADM, S1) stated they repositioned R1 3X per day and that R1 did not have any pressure injuries while in care. 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 ensure they repositioned resident is unsubstantiated. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 21, 2026 · control 15-AS-20251230120118

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Feb 20, 2026

In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights (4) 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. This requirement was not met as evidenced by staff left resident in soiled bedding which posed a potential health & safety risk to resident in care.the state’s words, verbatim · CDSS document, Jan 21, 2026

Plan of correction: By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on proper resident reappraisal in compliance with Section 87468.2(a)(4)

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Feb 20, 2026

All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by staff did not ensure resident’s cup was free of mold which posed a potential health & safety risk to resident in care.the state’s words, verbatim · CDSS document, Jan 21, 2026

Plan of correction: By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining on proper resident reappraisal in compliance with Section 87555(a)

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 20, 2026

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. This requirement was not met as evidenced by staff did not ensure the facility was not in financial distress which posed a potential health & safety risk to resident in care.the state’s words, verbatim · CDSS document, Jan 21, 2026

Plan of correction: By POC due date, ADM agrees to complete and submit to CCLD proof of water & PG&E paid statements for December 2025 and January 2026 with automatic payment scheduled every month to ensure the health and safety of residents are not compromised and facility is in compliance with Section 87303(a).

Type of visit: Required - 1 Year

On 04/22/25 at 12PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (S1) and explained the purpose of the visit. LPA spoke with ADM on the phone who authorized S1 to act on her behalf and sign the reports. LPA observed ADM has a current administrator certificate# 6056379740 which expires 09/26/2027. At 12:30PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. LPA observed kitchen table cover sticky. LPA also observed broken tile on kitchen counter and broken back porch sliding door screen. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 74 deg F. Hot water temperature was measured at 115 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Smoke and Carbon monoxide detectors were operational. LPA reviewed 2 staff and 2 resident files. Fire extinguisher was observed fully charged and last inspected on 05/21/24. Continued on next page, LIC 809-C The following deficiencies were observed during visit: Broken back porch sliding door screen. Sticky dining table cover in kitchen area. Broken kitchen counter tile Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Residents Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Deficiencies are 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.the state’s words, verbatim · CDSS document, Apr 22, 2025

From the deficiency page — Deficiency type: Type B · Plan of correction due date: May 23, 2025

The facility shall be clean, safe, sanitary and in good repair at all times This requirement was not met as evidenced by broken sliding door screen which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2025

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Apr 22, 2025

Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met due to sticky kitchen dining table cover surfaces which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2025

From the deficiency page — Deficiency type: Type B · Plan of correction due date: May 23, 2025

The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment This requirement was not met as evidenced by broken kitchen counter tile which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2025

Type of visit: Case Management - Other

On 05/21/24 while at the facility for another reason, Licensing Program Analyst (LPA) D Panlilio conducted a component III presentation with administrator (ADM)/ applicant. LPA discussed the common deficiencies that residential facilities for the elderly are cited on, Title 22 regulations on infection control, physical plant, personnel requirements on clearances and associations, training, emergency/disaster/food requirements, etc. ADM agreed to comply with Title 22 regulations. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 21, 2024

Type of visit: Prelicensing

On 05/21/24 at 1PM. Licensing Program Analyst (LPA) Daisy Panlilio arrived unannounced to conduct a pre-licensing inspection. LPA met with Administrator/Applicant (ADM) and explained the purpose of the visit. The facility is currently licensed as a Residential Care for the Elderly facility. ADM has a current administrator certificate # 6056379735 which expires 09/26/24. LPA observed 5 residents residing at the facility during visit. Fire clearance was granted on 05/06/24 for 6 non-ambulatory residents. LPA toured the facility with ADM including but not limited to the clients' bedrooms, common areas, kitchen, and outdoor area. LPA observed a screening station near the front entrance with a no touch temperature probe, visitors' log and hand sanitizer. Facility has adequate lighting. Indoor and outdoor passageways were observed free of obstruction. There were no bodies of water observed. LPA observed hot water temperature at 117 degrees F. Comfortable inside temperature was observed at 74 deg F. LPA observed 2 days supply of perishable and one week supply of non-perishable foods. Towels, sheets, activity supplies and hygiene products were observed available. The facility has 2 full bathrooms. LPA observed the shower area has non-skid floor tiles. Medications, sharps and toxic chemicals were observed locked inside cabinets. Facility has flashlights available for emergency use. LPA observed sufficient emergency supplies stored inside the garage. There is sufficient lighting throughout facility. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was observed fully charged and purchased on 05/24. Proper hand-washing signs, Emergency/Disaster plans/contact information, complaint poster and personal rights were observed posted in common areas. Continued on next page, LIC 809-C LPA observed no deficiencies during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 21, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census : 5 Method: Telephone call with CAB COMP II Participants: Rose Acholonu (Administrator/Licensee) & Tammy Edwards (Analyst). Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee's understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 16, 2024