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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 032701408
Report Date: 06/04/2026
Date Signed: 06/04/2026 03:44:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/08/2025 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20251008111928
FACILITY NAME:JACKSON HILLS ASSISTED LIVING LLCFACILITY NUMBER:
032701408
ADMINISTRATOR:JORDAN, JAMESFACILITY TYPE:
740
ADDRESS:223 NEW YORK RANCH ROADTELEPHONE:
(916) 212-0275
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY:70CENSUS: 59DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Nataliya Regan, Administrator DesigneeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility staff are not providing adequate food service to residents in care.
INVESTIGATION FINDINGS:
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On June 4, 2026, Licensing Program Analyst, Arvin Villanueva (LPA) arrived at this facility unannounced to conduct a follow-up investigation and to deliver findings relating to the allegations noted above. LPA met with administrator-designee, Natalya Regan (AD), and stated the purpose of the visit.

The investigation into the above allegation consisted of interviews, record reviews and observation.

During interviews, several residents said the food is often cold, burnt, undercooked, or poor in quality. They also reported that the menu is repetitive and that there are not enough choices, especially for people with special diets like diabetes.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/08/2025 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20251008111928

FACILITY NAME:JACKSON HILLS ASSISTED LIVING LLCFACILITY NUMBER:
032701408
ADMINISTRATOR:JORDAN, JAMESFACILITY TYPE:
740
ADDRESS:223 NEW YORK RANCH ROADTELEPHONE:
(916) 212-0275
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY:70CENSUS: 59DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Nataliya Regan, Administrator DesigneeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff are not providing activities for the residents in care.
INVESTIGATION FINDINGS:
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On June 4, 2026, Licensing Program Analyst, Arvin Villanueva (LPA) arrived at this facility unannounced to conduct a follow-up investigation and to deliver findings relating to the allegations noted above. LPA met with administrator-designee, Natalya Regan (AD), and stated the purpose of the visit.

The investigation into the above allegation consisted of interviews and record reviews.

During resident interviews, none of the residents reported concerns about activities. Residents said the facility provides daily activities, such as bingo, exercise, and special holiday themed events. Staff interviews also confirmed that activities are offered regularly.

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Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20251008111928
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: JACKSON HILLS ASSISTED LIVING LLC
FACILITY NUMBER: 032701408
VISIT DATE: 06/04/2026
NARRATIVE
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A review of activity calendars from October 2025 through February 2026 showed a wide variety of daily activities, including exercise groups, bingo, music programs, church services, art and craft therapy, dog therapy, van rides, nail care, table games, card games, and resident council meetings.

Observations made on 12/19/25, 2/4/26, 2/19/25, 4/10/26, and 6/4/26 showed activities taking place, with residents participating in group games, watching TV, and using materials in the activity area. On 2/4/26, the activity room was full of residents, and the activity staff showed this LPA videos of several table games completed earlier that day. Activity calendars were observed to be posted in the lobby and activity room.

Based on interviews, records reviewed, and direct observations, there is no evidence to support the allegation that staff are not providing activities to residents in care. Therefore, the allegation is unfounded.

Report was reviewed during exit interview with AD and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20251008111928
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JACKSON HILLS ASSISTED LIVING LLC
FACILITY NUMBER: 032701408
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/11/2026
Section Cited
CCR
87555(a)
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The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents...

This is not met as evidenced by:
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Per discussion, the administrator will submit a written statement of understanding of the regulation cited relating to the regulatory requirement for food service by POC due date.
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Based on interviews, record reviews and observation, evidence showed that facility were not consistent in meeting resident food service needs. This poses a potential health, safety, and/or personal rights risks to persons in care.
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Per interview, facility is currently addressing the ongoing concerns of their residents and will continue to do so.
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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: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 27-AS-20251008111928
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: JACKSON HILLS ASSISTED LIVING LLC
FACILITY NUMBER: 032701408
VISIT DATE: 06/04/2026
NARRATIVE
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Staff interviewed explained that the previous kitchen supervisor did not order food supplies on time, which causes the facility to run out of basic items such as juice, creamer, and butter. Staff also stated that when they report problems to management, their concerns “fall on deaf ears.”

Photos reviewed showed examples of burnt or poorly prepared meals recently served to residents. Reviews of records, including resident council meeting notes from 2025 to 2026 showed ongoing issues over many months, including cold food, small portions, greasy meals, late meal service, lack of variety, unclear menu changes, and not enough staffing in the dining room.

In addition, observation by LPA Wolf Peterson from August 2025 showed long delays in meal service, low calorie meals, flies in the kitchen, and contractors entering the kitchen during meal service without barriers, raising safety concerns.

During an interview with management staff, they stated they have been gradually addressing these issues and will continue working on any food service concerns moving forward. While the efforts were noted, the evidence still shows the facility has not consistently met residents’ food service needs. Therefore, this allegation is substantiated.

Deficiencies were being cited per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8. An immediate civil penalty of $1000 is hereby assessed due to a repeat violation of the regulation CCR 87555(a). Failure to make and submit corrections may result in additional civil penalties.

Review of this report and discussion of plan of correction were conducted at the exit interview with AD. A copy of this report and appeal rights were provided.

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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5