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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201319
Report Date: 07/16/2026
Date Signed: 07/16/2026 12:09:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
12/26/2025 and conducted by Evaluator Ardalan Gharachorloo
COMPLAINT CONTROL NUMBER: 15-AS-20251226084420
FACILITY NAME:ANGELEON CARE HOMEFACILITY NUMBER:
019201319
ADMINISTRATOR:DE LEON, RICHARDFACILITY TYPE:
740
ADDRESS:2124 ASHBY AVENUETELEPHONE:
(650) 692-8945
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY:12CENSUS: 11DATE:
07/16/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Danilo Villar, Care StaffTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff do not ensure facility toilets are kept in good repair.
Staff do not ensure the residents shared bathroom are clean and sanitary
Staff do not ensure the residents medication is properly stored
Staff do not ensure there is sufficient dining space for residents
INVESTIGATION FINDINGS:
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On 12/30/2025 at 10:00 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to continue investigation and to deliver findings in regard to the allegations above. LPA met with care staff, Danilo Villar and explained the purpose of the visit. At 10:20 AM, LPA called and spoke to Administrator Richard De Leon over the phone and explained the purpose of the visit. Administrator was unable to be present during the visit.

Over the course of the investigation, LPA reviewed facility files including LIC 308 and LIC 500, toured the facility including the kitchen, resident bathrooms, five resident rooms, common areas, dining area, backyard, and storage room. LPA reviewed a sample of three residents' medications, reviewed five resident files (R1-R5) and five staff files (S1-S5) , and interviewed Five residents(R1-R5) and two staff(S1-S2).

Allegation: Staff do not ensure facility toilets are kept in good repair. Unsubstantiated

***CONTINUE ON 9099C***

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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-20251226084420
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ANGELEON CARE HOME
FACILITY NUMBER: 019201319
VISIT DATE: 07/16/2026
NARRATIVE
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***CONTINUE FROM 8099***

It was alleged that the hallway bathroom toilet was not flushing properly. During the investigation, LPA toured the facility and observed the shared resident bathrooms and two bathrooms in the common hallway.At the time of the visit on 07/16/2026 and 12/30/2025, the toilets observed were operational with no issues noted. LPA interviewed five residents (R1-R5) regarding the condition of the bathrooms. Residents stated they had no concerns with the toilets.

Allegation: Staff do not ensure the residents' shared bathrooms are clean and sanitary. Unsubstantiated

It was alleged that staff were not keeping the shared resident bathrooms clean and sanitary because trash liners were not being changed regularly. During the facility tour, LPA observed the shared resident bathrooms and did not observe unsanitary conditions or overflowing trash. Residents interviewed stated they were satisfied with the cleanliness of the facility. One resident stated, "The staff keep everything clean and take good care of us." LPA also interviewed R2-R4 who expressed no concerns with bathroom condition. LPA also interviewed S2 who stated that "bathrooms are scheduled to be cleaned daily". during visit LPA observed that S2 was cleaning the hallway bathroom.

Allegation: Staff do not ensure residents' medication is properly stored. Unsubstantiated

During the investigation, LPA toured the facility and observed the medication storage in the facility. LPA reviewed a sample of three residents' medications and observed medication storage practices. LPA also reviewed resident records including MARs and interviewed S1 and S2. S2's file including training documents were reviewed. LPA observed that the medication storage was locked during two visits on 07/16/2026 and 12/30/2025.

Allegation: Staff do not ensure there is sufficient dining space for residents. Unsubstantiated

LPA observed the dining area and counted nine chairs available for residents on 12/30/2025 during visit. on 7/16/2026 LPA observed 10 chairs for residents in the dining area. S2 stated that " residents always have a chair to use and never have issues with sitting". Five Residents (R1-R5) interviewed stated they had no concerns regarding seating or access to meals.LPA did not observe any residents waiting for seating during two visits on 7/16/2026 and 12/30/2025.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20251226084420
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ANGELEON CARE HOME
FACILITY NUMBER: 019201319
VISIT DATE: 07/16/2026
NARRATIVE
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***CONTINUE FROM 9099C***

This agency has investigated the allegations above. We have found that the allegations were unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3