JPS Home Care Services

Type of visit: Required - 1 Year

08/25/2026, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required inspection visit. There are currently five residents in care. Facility has an approved fire clearance for six non-ambulatory and a hospice waiver granted for 3. LPA was greeted by caregiver. Administrator, Jully Cartel and Assistant Administrator, Olive Pangilinen arrived shortly after. LPA and caregiver toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner with food items being labeled and dated. All rooms were furnished and in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured to be within the range of 105 to 120 degrees F. LPA observed garage door to be broken, conversation with Assistant Administrator stated they recently started doing renovations and the garage door will be getting repaired. Outside emergency exit pathways were found to be obstruction free. Fire extinguishers were recently purchased on 08/03/2026. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational. Chemicals and knives were located in the kitchen and found to be secured. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA conducted a review of four resident records. All records had the required documentation. LPA conducted review of four staff records/training. Upon a review of staff records, LPA found all staff to have required training. One out of four staff did not have a current 1st Aid & CPR certification on file (Technical Violation). Two out of four staff to not have a health screening and tb test completed on file. (Deficiency Cited) continued on LIC809C Facility was unable to provide proof of emergency drills being conducted. (Technical Violation) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Updated copies of the following documents were requested and are to be submitted to CCL by 09/25/2026: LIC500- Personnel Report LIC9020- Register of Facility Clients/Residents Updated Certification of Liability Insurance Copy of report was provided along with Appeal Rights, LIC809D, and LIC811 Confidential Names.the state’s words, verbatim · CDSS document, Aug 25, 2026

Type of visit: Office

On 06/17/2026, an informal office meeting was conducted in the Santa Rosa Regional Office. Present in the meeting were Licensing Program Manager (LPM), Kimberley Mota, Licensing Program Analyst, (LPA) Anthony Loera, Administrator, Jully Cartel and Assistant Administrator, Olive Pangilinen. The purpose of the informal office meeting was to discuss areas of non-compliance and observed Community Care Licensing (CCL) concerns of the operation of JPS Home Care Services. The Administrator was informed that this informal meeting is a part of the Administrative Action process and that further and/or repeat citations may result in a formal Non-Compliance Plan. Issues discussed during the meeting were: Administrator duties and qualification Staffing Care and Supervision Reporting requirements LPA discussed Technical Support Program with Administrator who agreed to referral. Copy of report was provided to Administrator.the state’s words, verbatim · CDSS document, Jun 17, 2026

Type of visit: Case Management - Other

04/14/2026; LPA arrived to conduct a case management visit and was greeted by caregiver. LPA was notified by staff that Licensee, Evelyn Serrano was out of town in a meeting. LPA was also notified Administrator, Jully Cartel was out on vacation. Assistant Administrator Olivia Pangilinen arrived shortly after. LPA conducted interviews and was notified by caregiver and Assistant Administrator that resident (R1) had passed away September 11th, 2025. Facility did not report the death of R1 to Community Care Licensing (CCL). (Deficiency Cited) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Copy of report was provided along with Appeal Rights, LIC809D, and LIC811 (confidential names).the state’s words, verbatim · CDSS document, Apr 14, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Apr 24, 2026

87211 Reporting Requirements (a) Each licensee shall furnish... (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement not met by licensee as evidenced by: Based on LPA record review and interview, the licensee did not comply with the section cited above as facility did not report R1s death to CCL which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Licensee to self-certify that they will maintain compiance with all reporting requirements as outlined in regualtion 87211. Plan of Correction to be submitted to CCL by 04/24/2026.

Allegation investigated: Staff are not providing adequate care and supervision of a resident Staff are not meeting a resident's incontinence needs

Licensing Program Analyst (LPA) Loera arrived unannounced and met with Olivia Pangilinen, Caregiver to deliver findings of a complaint investigation. During the course of this investigation, documents were reviewed, outside record of videos were reviewed, observations made, and interviews conducted. Complaint alleges staff are not providing adequate care and supervision of a resident and staff are not meeting a resident's incontinence needs. Allegation, staff are not providing adequate care and supervision of a resident. During the investigation, outside video recordings and statements were reviewed, interviews conducted, and observations made. A review of a video recording of residents (R1 & R2) revealed that staff (S1) left R1 without assistance. S1 stated they were following behind R1 and R2 in the driveway, however whether S1 was following behind R1 and R2, video record shows R1 still needed assistance that they did not receive. Video shows R2 helping R1 sit in their wheelchair with no assistance from S1. continued on LIC9099C Substantiated Complaint alleges staff are not meeting a resident’s incontinence needs, based on interviews that were conducted with facility staff and residents, and records reviewed, it was determined resident (R1) has difficulty functioning on their own as per their Needs and Service plan dated 03/31/2025 under physical/health. Interviews conducted with 2 of 3 residents state they have heard R1 at night calling for help for hours with no assistance from staff on duty to assist R1. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Division 6, Chapter1 is being cited on the attached LIC 9099D. Appeal rights given.the state’s words, verbatim · CDSS document, Aug 28, 2025 · control 21-AS-20250623094939

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(6) · Plan of correction due date: Aug 29, 2025

§1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs... This requirement is not met by licensee as evidence by video review and interviews...... conducted, the licensee did not ensure R1 received assistance from S1 and/or staff on duty. This poses an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: Facility will submit plan to CCL to conduct personal rights training and training for all direct care staff on care and supervision by plan of correction due date 08/29/2025. Facility to submit proof of completed training to CCL by 09/10/25.

Allegation investigated: Staff failed to safeguard residents' cash resources

Licensing Program Analyst (LPA) Loera arrived unannounced and met with Olivia Pangilinen, Caregiver to deliver findings of a complaint investigation. During the course of this investigation, documents were reviewed, observations made, and interviews conducted from outside parties. Complaint alleges staff failed to safeguard residents' cash resources. During the course of the investigation, LPA was informed resident (R1) receives checks from an outside agency that is provided and written to the facility. It was reported that R1 was written two (2) separate checks for $200.00 on May 20, 2025 and One (1) check in the amount of $500.00 written on May 28, 2025. Complaint alleges (R1) did not receive the check written on May 28, 2025. LPA was provided with conflicting information about funds for both checks being written, as to who wrote them and when they were cashed. Interviews conducted with all parties revealed (R1) did receive their funds in the full amount. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 29, 2025 · control 21-AS-20250619153050

Type of visit: Required - 1 Year

07/29/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 5 residents in care. Facility approved/cleared for 6 ambulatory, of which 6 may be non-ambulatory and a hospice waiver for 3. LPA met with Evelyn Serrano, Licensee and Jully Cartel, Administrator. Both Licensee and Administrator gave permission for Caregiver to sign report. LPA and caregiver toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 126.8 and 123.0 falling out of regulation range of 105 to 120 degrees F (Deficiency Cited). Fire extinguishers were charged and last purchased 09/05/2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins, sharps and other items that could pose threat if available to residents were located under the kitchen sink and found to be secured. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA conducted a review of 5 resident records. All records had the required documentation. However, LPA observed 2 of the 5 residents to not have an updated medical assessment (Technical Violation). LPA spoke with caregiver about ensuring residents receive an annual visit with a medical professional once every 12 months. Continued on LIC809-C LPA conducted review of 4 staff records/training. Upon a review of staff records, LPA found 3 out of 4 staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. LPA found 1 out of 4 staff to have missing 4 hours of dementia training. LPA spoke with staff about ensuring they complete the 8 hours of required dementia care training. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 08/29/2025: LIC308- Designation of Responsibility Updated Liability Insurance Register of Facility Clients/Residents Exit interview conducted with Caregiver and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 29, 2025

Allegation investigated: Facility staff do not maintain bathrooms in a clean condition

On 04/04/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of initiating a complaint investigation regarding the above complaint and delivering complaint findings. LPA arrived and met with Olivia Pangilinen, Caregiver. During the investigation, LPA made observations. Compliant alleges, Facility bathrooms are "filthy". Based upon department interviews with staff and observations, information provided was contradicting with a lack of corroborating evidence to support the allegation. LPA did a physical plant tour. Facility has three bathroom, two are resident bathrooms and one is a staff bathroom located in the staff room. LPA observation all bathrooms to be clean. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 4, 2025 · control 21-AS-20250402114352

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) M Cuadra arrived unannounced to conduct an annual required one year inspection, LPA was greeted by staff and Licensee, Evelyn Serrano arrived later. There are currently 5 residents in care. No residents receiving hospice services at the moment. Annual fees are current. Contact information was reviewed. Required postings were observed. LPA/staff toured the facility inside and outside observed the following: the facility was at comfortable temperature with all exits free from obstruction. Some window screens needs to be cleaned (technical advisory was issued). Bedrooms were furnished per regulation. Smoke detectors and carbon monoxide detectors were tested and operational. Fire extinguisher were observed charged and service as of 9/5/2024. Licensee told LPA that the facility have not conducted a disaster drill within the last quarter (technical violation was issued). At approximate 9:25am water temperature in the resident's restroom measured 127 and 134.4 f degrees, which is not within range of 105 to 120 F degrees. Bathrooms have required non-skid surfaces and grab bars. At approximate 9:35am during physical tour of the facility, LPA/Licensee observed 3 litter of liquid soap, spray bottle 32 oz of disinfectant, Clorox bleach 32 oz and other cleaning solution bottles and disinfectants located under the sink were unlocked and accessible to residents. Linens and paper products were available. There was a one week supply of non-perishable foods and two days of perishable foods. LPA/Licensee observed in the refrigerator food not labeled and stored per regulation (technical violation was issued). LPA did not observe any staff encouraging activities to residents in care (technical violation was issued). Per Licensee, the residents are regularly taken to the park, bingo or watch television. LPA/Licensee discussed the importance and requirement to offer and provide daily activities to residents in care. Licensee agreed to re assess their current activity calendar and upgrade it as needed. Medication and medication records were reviewed. Medication was locked. Continue on LIC809C... Continues from LIC809... At approximate 10am LPA initiated file review of five residents and three staff files. Two out of three staff (S1 & S2) do not an additional 20 training hours annually completed. All staff have proof of CPR/1st aid training. Four out of five resident's (R1, R2, R3 & R4) care plan was not reviewed within the last 12 months. All residents have current medical assessment. However, LPA/Licensee discussed the importance to have some of medical assessments updated regularly to ensure that resident's needs have not changed over time. Upon review of administrator information it was revealed that the facility needs to submit a change of administrator to Jocelyn Sebastian #606175940 expires 9/1/2024. However, last annual conducted on 9/15/23 and a case management conducted on 6/10/24; LPA Canela have requested to the facility to submit required paperwork to update the Administrator by not later than 6/19/24, but the Licensee did not submit documentation requested by the Department. Per Licensee, current administrator Lolita P. is a backup administrator and they have an acting administrator Jocelyn Sebastian who is currently recovering from surgery. However, none of the administrator mentioned do have an active administrator certificate as of today yet. LPA reviewed the Department's active/pending lists and there are no evidence that they have submit required documentation. Licensee agreed to appoint a new administrator and send required documentation (LIC 215 Applicant Information, Administrator Resume, Administrator certificate, LIC 500 Personnel Report and LIC 501 Personnel Record) to the Department by not later than September 25, 2024. Licensee agreed to submit the current following documents by 9/25/2024: LIC 308 Designation of Facility Responsibility, LIC 610E Emergency Disaster Plan (if there are any changes) and copy of Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights given. Exit interview conducted with Licensee and copy of this report was given.the state’s words, verbatim · CDSS document, Sep 19, 2024

The state marks this report as 9 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Facility is not meeting resident's needs

Licensing Program Analyst (LPA), Araceli Canela arrived unannounced, for the purpose of continuing complaint investigation and delivering findings, regarding the above listed allegation. LPA toured the home, took statements, made observations, reviewed records, and conducted a medication count for resident R1. It was alleged facility is not meeting residents needs and are also not able to handle R1's diagnoses of COPD. On 6/10/2024, LPA reviewed R1s medication records and reviewed medication. Investigation revealed there was several medication bottles that had too much medication and should have been finished if taken according to when the medication was picked up and physicians orders. Continue report see LIC9099-C Substantiated Continued report from LIC9099 Several medications were for helping and improving breathing problems and many of these medications were started but not finished and some had not been picked up for several months. Licensee expressed R1 refused to take medication several times and was also admitted at the hospital several times and that is why there was extra medicine. The facility had no proof or documentation on why there was extra medication. Based on the above information the, Allegation, Facility is not meeting resident's needs, is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, Jul 8, 2024 · control 21-AS-20240606160922

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jul 9, 2024

87465(a)(4) Incidental Medical and Dental Care-A plan for incidental medical & dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The licensee shall assist residents with self-administered medications as needed. This requirement was not met- As evidenced by: During medication audit of 6/10/2024 and today, the facility failed to properly provide some medication to R1. (Prednisone, Albuterol, Doxyclyne/antibiotic, verapamil) This is an immediate risk to the Health & Safety of residents in carethe state’s words, verbatim · CDSS document, Jul 8, 2024

Plan of correction: Facility to send in written plan on how they will ensure compliance for meeting residents needs and medication training. First POC due date for written plan due 7/9/2024, with follow up by 7/16/2024 for proof of medication training. POC due to LPA Araceli Canela

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Canela arrived unannounced and met with Licensee, Evelyn Serrano. During the course of a complaint investigation, LPA discovered the facility failed to report several incidents for R1 to Community Care Licensing as required. Review of medical records also revealed the facility is not properly documenting the centrally stored log as required and the Medication Administration Record that the facility is using, is also not being properly documented. LPA requested facility to submit paperwork to change the current Administrator, by 6/19/2024. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, Jun 10, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Jun 28, 2024

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement was not met as evidenced by: The facility failed to properly document the centrally stored medication log as required for all residents. This is a potential risk to the health & safety of residents in care.the state’s words, verbatim · CDSS document, Jun 10, 2024

Plan of correction: Facility to send in written plan on how they will make sure the centrally store log is being properly documented for all residents. Administrators plan to review an make sure the facility is documenting properly. Plan of correction due by 6/28/2024 attention LPA A Canela

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(D) · Plan of correction due date: Jun 17, 2024

87211(a)(1)(D)Reporting Requirements (a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by: The facility failed to report several incidents for resident R1. This is a potential risk to the health & safety of residents in carethe state’s words, verbatim · CDSS document, Jun 10, 2024

Plan of correction: Facility to send in all missing incident reports that were not submitted regarding resident R1 and any other reportable incidents. Facility to send in written plan on how they will make sure the facility stays in compliance. Plan of correction due by 6/17/2024 attention LPA A Canela