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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 03:42:44 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
04/03/2026 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20260403145341
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: DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Natalya Regan, Administrator DesigneeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are not responding to resident council concerns.
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.

Interviews with residents showed that the facility does not give written responses to the concerns they bring up during Resident Council meetings. Residents stated that they have been raising the same issues for a long time and have not received any written follow up from staff.

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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 3
Control Number 27-AS-20260403145341
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 interviews confirmed that they receive the Resident Council meeting notes and try to talk to residents about the concerns. Per staff interview, they response in writing usually the next day; however, they stated that they do not keep a copy of the written responses for their records. Staff stated they provided copy of the written responses to the president of the resident council. The provided copy of responses from May 15, 2026 and April 9, 2026. According to staff, they do not keep copy of their written responses they provide to the resident council president. Facility does not have other documentation to prove that written responses were provided to residents.

Records explains that since last year, the Resident Council has been submitting meeting minutes to the facility, but the facility has not provided any written response or met the 14 day deadline. Records also shows that many dining concerns listed by residents—such as burnt or cold food, last minute menu changes, inconsistent menus, lack of variety in fruits and vegetables, and not enough staff in the dining room—have continued for a long time without being fixed. Records further notes that the facility makes changes to the menu or meal options without clear communication to residents, which causes confusion.

Based on interviews and record reviews, the preponderance of evidence is met which shows that the facility is not responding to Resident Council concerns as required. Therefore, this allegation is substantiated.

Deficiencies were being cited per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8.


Plan of correction and appeal rights were discussed during 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: 2 of 3
Control Number 27-AS-20260403145341
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
HSC
1569.157(c)
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If a resident council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response to those concerns or recommendations within 14 calendar days.
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Per discussion, the administrator will submit a written statement of understanding of the regulation HSC 1569.157 relating to the regulatory requirement regarding resident council by POC due date.
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This requirement is not met as evideced by: based on interviews and record reivews, facility do not provide written responses to the residents within 14 days. This poses a potential health, safety, and/or personal rights risks to persons 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: 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: 3 of 3