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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201028
Report Date: 07/20/2026
Date Signed: 08/03/2026 02:53:06 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
07/16/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260716113337
FACILITY NAME:PERRY'S HOME CAREFACILITY NUMBER:
079201028
ADMINISTRATOR:PERRY, PALMER JASONFACILITY TYPE:
740
ADDRESS:2404 SILVERADO DRIVETELEPHONE:
(925) 206-4561
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: DATE:
07/20/2026
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Jason Perry, AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Licensee has installed cameras that monitors audio
INVESTIGATION FINDINGS:
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On 08/03/26 at 1:30PM, 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 07/20/26.

Allegation: Licensee has installed cameras that monitors audio
Investigation Finding: Substantiated
On 07/20/26 at 3:30PM, LPA toured the facility including but not limited to residents’ bedrooms, bathrooms, living room, kitchen and dining areas. LPA observed facility had inside cameras with audio capability in the kitchen, dining, and living room areas. ADM confirmed with LPA that inside cameras had audio capability and agreed to remove them permanently during visit. 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) was found to be substantiated.

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: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
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 6
Control Number 15-AS-20260716113337
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: PERRY'S HOME CARE
FACILITY NUMBER: 079201028
VISIT DATE: 07/20/2026
NARRATIVE
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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: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 15-AS-20260716113337
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: PERRY'S HOME CARE
FACILITY NUMBER: 079201028
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2026
Section Cited
CCR
87468.1(a)(1)
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To be accorded dignity in their personal relationships with staff, residents, and other persons.
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Deficiency corrected during visit.

ADM permanently removed all video cameras in the living, dining, kitchen and hallway areas.
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This requirement was not met as evidenced by video cameras with audio being used in the living, dining, kitchen and hallway areas. which posed a potential health & safely 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.
SUPERVISOR'S NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
07/16/2026 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20260716113337

FACILITY NAME:PERRY'S HOME CAREFACILITY NUMBER:
079201028
ADMINISTRATOR:PERRY, PALMER JASONFACILITY TYPE:
740
ADDRESS:2404 SILVERADO DRIVETELEPHONE:
(925) 206-4561
CITY:ANTIOCHSTATE:CAZIP CODE:
94509
CAPACITY:6CENSUS: DATE:
07/20/2026
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Jason Perry, AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff did not meet resident's incontinence needs
Staff prevent resident from accessing bedroom
Staff do not ensure sheets are readily available to resident
INVESTIGATION FINDINGS:
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On 07/20/26 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted a complaint visit, met with staff (ADM, S1), gathered information and delivered investigation findings to staff. LPA explained the purpose of the visit with staff.

At 3:10PM, LPA conducted interviews with staff (ADM, S1), resident (R1), reviewed and obtained the following documents: Personnel record (LIC500), Residents roster, R1's admission agreement, appraisals /needs & services plan, physician's report and incident reports. At 3:30PM, LPA toured the facility including but not limited to resident's bedrooms, bathrooms,living room, kitchen and dining areas. LPA observed facility has inside cameras with audio capability in the kitchen, dining, living room areas. ADM confirmed with LPA that inside cameras had audio capability and agreed to remove them permanently during visit.

Continued on next page, LIC 9099-C pg1
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
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 6
Control Number 15-AS-20260716113337
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: PERRY'S HOME CARE
FACILITY NUMBER: 079201028
VISIT DATE: 07/20/2026
NARRATIVE
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Allegation: Staff did not meet resident's incontinence needs
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with resident (R1), facility staff (ADM, S1) and reviewed resident (R1) documents. R1's admission agreement showed he was first admitted at the facility on 03/07/26. LPA observed R1 to be coherent, does not wear a diaper and can independently use the toilet when needed using his walker. He ambulates with a walker and has a wheelchair that uses daily. R1 stated that he uses the toilet every 1 1/2 hours and is happy living at the home. R1 stated that he does not wear any diaper during the day and uses the toilet independently every 1 1/2 hours. R1 stated that he is independent with his toileting and personal hygiene. 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 is UNSUBSTANTIATED.

Allegation: Staff prevent resident from accessing bedroom
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with resident (R1), facility staff (ADM, S1) and reviewed resident (R1) documents. During visit, LPA interviewed R1 who stated that he prefers to relax in his wheelchair or exercise in the back patio during the day. He stated that staff make up his bed if he requests to go back to bed during the day. He stated that staff does not prevent him from accessing his bedroom. Staff denied preventing R1 in using his bedroom and bed during the day. 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 is UNSUBSTANTIATED.

Continued on next page, LIC 9099-C pg2
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 15-AS-20260716113337
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: PERRY'S HOME CARE
FACILITY NUMBER: 079201028
VISIT DATE: 07/20/2026
NARRATIVE
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Allegation: Staff do not ensure sheets are readily available to resident
Investigation Finding: Unsubstantiated
During investigation, LPA conducted interviews with resident (R1), facility staff (ADM, S1) and reviewed resident (R1) documents. ADM stated that R1's beddings (mattress pad and linens) are cleaned, aired out and sanitized daily because he poops and urinates in his diapers during the night which leaks onto the beddings. During visit, LPA interviewed R1 who stated that staff make up his bed if he requests to go back to bed during the day and that his bed is always clean and odor free. Staff stated that they prepare his mattress with covers, pads and ensures sheets readily available to R1 at all times. 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 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: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6