Jazba Care Tuolumne

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to open this complaint investigation. LPA Moleski met with facility administrator Sangeetha Vipulananda and explained the purpose of the visit. This investigation consisted of observation, interviews, and record review. LPA Moleski reviewed a resident's file (R1). LPA Moleski observed that they had an admission agreement for another facility, but not this facility. LPA Moleski reviewed an incident reporting an unwitnessed fall suffered by R1. According to the incident report, R1 was admitted to this facility on 7/5/25 and was sent to the hospital on 7/10/25. Vipulananda said that R1 did not return to this facility after hospitalization. LPA Moleski reviewed the files of six current residents (R2-R7). [continued on 9099-C] SubstantiatedRead the full finding— CDSS inspection report, July 15, 2025 · control 27-AS-20250714090127

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Shane Stumpf and explained the purpose of this visit. This investigation consisted of record review. LPA Moleski reviewed personnel records for six staff members (S1-S6). LPA Moleski observed that all six of these staff members had training records documenting 20 hours of initial training. However, none of these six staff members had documentation of completing the required 40 hours of initial training within their first four weeks of employment, per HSC Section 1569.625(b)(1). 22 CCR Section 87412(c) states that “Licensees shall maintain in the personnel records verification of required staff training and orientation.” [continued on 9099-C] SubstantiatedRead the full finding— CDSS inspection report, June 12, 2024 · control 27-AS-20240321114138

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Shane Stumpf and explained the purpose of the visit. This investigation consisted of interviews and record review. According to Stumpf, emergency disaster drills have been conducted during staff meetings, which were not mandatory for all staff to attend. The drills were not conducted during each consecutive shift, but staff members of all shifts were invited to attend. LPA Moleski reviewed staff meeting agendas from February 2022 to present. For the year of 2022, LPA Moleski observed four staff meeting agendas from February, May, July, and November. [continued on 9099-C] SubstantiatedRead the full finding— CDSS inspection report, June 12, 2024 · control 27-AS-20240419113158

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to open this complaint investigation. LPA Moleski met with facility administrator Shane Stumpf and explained the purpose of the visit. When LPA Moleski arrived at the facility, one staff member was present (S1). In an interview, S1 said that S1 had been working at the facility since November or December 2023. LPA Moleski reviewed Guardian records and observed that S1 was associated to the facility as of 3/26/24, one day after LPA Moleski opened a separate complaint investigation regarding criminal record clearances at another facility owned and/or operated by Stumpf. S1 said S1 had been working six days a week at the facility since starting. S1 said S1 had been working with S2 for about a month. [continued on 9099-C] SubstantiatedRead the full finding— CDSS inspection report, March 29, 2024 · control 27-AS-20240321114138

Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 10/19/2022 at 8:50 am to deliver complaint findings, LPA met with Shane Stumpf and explained the purpose of the visit. Throughout the course of the investigation, LPA Martinez conducted interviews and reviewed facility records. LPA Martinez reviewed resident 1 (R1) medication orders, medication list, and Medication Administration Record (MAR), and Centrally Stored Medication And Destruction Record (CSMDR). The facility CSMDR record logged Amlodipine 5MG was filled January 27, 2022 and no start date. LPA Martinez reviewed R1's April 2022 Medication list, which stated Amlodipine 5MG. LPA Martinez reviewed R1's May MAR, which stated Amlodipine 2.5 MG and the first part of the May Mar was not completed. Furthermore, there was no discontinuance order for the 5MG and no start order for the 2.5 MG in May of 2022. However, a September 9, 2022 medical doctor order states Amlodipine dosage was changed to 2.5Read the full finding— CDSS inspection report, October 19, 2022 · control 27-AS-20220912150514

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Jazba Care LLC on 6/2/22 at 1:15pm to conclude the investigation of the above allegations and to deliver the findings. LPA met with Licensee and together discussed the investigation details. Based on the interviews conducted and statements obtained during the investigation process, the allegations cannot be corroborated because the facility and department has received no documentation from individuals who have been designated as having power of attorney (POA) had not provided to the facility any documentation from a physician that resident has been incapacitated an can no longer make their own medical decisions. Therefore, the resident's POA and POA for medical decision making has not been triggered at the time of writing this report. The department has determined that the resident has retained the right to their own decision making and the facility cannot share the information without the approval of theRead the full finding— CDSS inspection report, June 2, 2022 · control 27-AS-20220510154943

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Jazba Care LLC (RCFE) on 4/7/22 at 1:15pm to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated because no resident or family member interviewed provided statements that they could not visit the facility. LPA Gould conducted interviews with four of the five residents family members and all family interviewed had positive impressions of the facility and staff. No family member interviewed stated they were told not to visit the facility and no family member identified a resident or family member had tested positive at the facility. LPA Gould conducted interviews with two of the five residents and all confirmed they have had visitors and were not aware of any residents in the facility teRead the full finding— CDSS inspection report, April 7, 2022 · control 27-AS-20220225131405