Jrbella Home for the Elderly

Allegation investigated: Staff is overcharging a resident

On 12/03/25, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator, Nestor Tumaliuan. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint. On 12/03/25, at 9:35am, LPA Saucedo asked for the census, staff, and client rosters. On 12/03/25, at 9:55am, LPA Saucedo conducted a physical tour, interviewed staff and attempted to interview residents. LIC 9099C-continued Unsubstantiated Regarding the allegation: Staff unlawfully evicted a resident. It is being alleged that on November 21, 2025, Resident #1 (R1) was medically stable for discharge but the facility did not want them back. LPA reviewed the facilities admission agreement regarding R1, R1’s pre-placement appraisal information, appraisal/needs and services plan, and physician's report. There was no updates to any of the documents since Admission of 2024. There were no resident appraisal and/or updated reappraisals conducted for R1 showing the process of higher level of care for R1 which staff #1 (S1) based their denial of accepting R1 back into the facility. There was no eviction notice given to the resident, resident’s family and Community Care Licensing Department about not accepting/readmitting R1 back to the facility from the hospital. The pre-placement appraisal, physician's report and appraisal/needs and services plan remained the same since R1's admission to the facility confirming that R1 needed total care at the time of admission. Therefore, based on the LPA's record reviews and staff interviews conducted, the allegation is SUBSTANTIATED at this time. An exit interview was conducted, citation(s) were issued, appeal rights were provided, and a copy of this report was given to the administrator. Regarding the allegation: Staff is overcharging a resident. It is being alleged that resident #1 (R1)’s family member paid $4200.00 for the month of November and R1 was not at the facility. R1 was at a Community Living Center for 31 days prior and 14 days at a medical center. During LPA’s interview with a witness, the witness did confirm that R1 still had to pay for rent at the above facility although they were not there for over thirty (30) days. During LPA’s interview with the staff #1 (S1), S1 did confirm that R1 had to pay $4200.00 for their rent because R1’s family did confirm that R1 would be returning and R1’s belongings were still being held at the facility in their room. Upon reviewing R1’s admission agreement, LPA reviewed that the facility will not make a refund of the preadmission fee for residents living in the facility for four (4) or more months. R1 lived in the facility for more than a year. The refund policy also states, "...facility will not refund the resident and/or resident's representative in the event of death, transfer or relocation or any other circumstance upon the departure of the resident." Therefore, based on the LPA's record reviews and staff interviews conducted, the allegation is UNSUBSTANTIATED at this time. An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Dec 3, 2025 · control 31-AS-20251201104955

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Dec 17, 2025

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required...This requirement is not met by: Based on the LPA's Interviews the licensee/administrator failed to ensure that resident #1 (R1) was not given the proper 30 (thirty) day notice for eviction. R1 was not allowed back to the facility after hospitalization discharge. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 3, 2025

Plan of correction: Licensee/Administrator will ensure to send community care licensing department a proper thirty (30) day notice regarding R1 The POC due date: 12/17/25

Type of visit: Case Management - Other

On 12/03/25, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator, Nestor Tumaliuan. This Case Management is conjunction with complaint number-31-AS-20251201104955. LPA did not get an Unusual/Incident Injury report regarding resident #1 (R1) going to the hospital and their extensive stay there. Therefore, a citation is being provided. An exit interview was conducted, citation(s) were issued, appeal rights were provided, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Dec 3, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Dec 11, 2025

87211Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports at the department... (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. This requirement is not met by: Based on the LPA's Interviews the licensee/administrator failed to ensure that resident #1 (R1)'s unusual/incident injury reports were sent to CCLD and/or LPA. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 3, 2025

Plan of correction: Licensee/Administrator will ensure to send community care licensing department (CCLD) all unusual/incident injury reports regarding all residents including when R1 first went to the hospital. The POC due date: 12/11/25

Type of visit: Required - 1 Year

On 11/03/25 at 9:10AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with administrator Nestor Tumaliuan and disclosed the purpose of the visit. LPA asked for the census, resident, and staff rosters. A physical tour was conducted at 9:35AM and observed the following: The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The fire extinguisher is located against the wall on your left-hand side towards the staff room and garage area. It is fully charged and dated 10/2025. There is a telephone line on the counter in the kitchen. There is extra, food in the kitchen pantries. The medications are locked and inaccessible to the residents in one (1) of the top cabinets on your right-hand side. The knives are at the bottom of the sink on your left-side of one of the cabinets locked and inaccessible to the residents. The chemicals/toxins are under the sink also locked and inaccessible to the residents. The first aid kit is in a cabinet area on your right side of the kitchen entrance. Outside/Backyard: The outside/backyard has furniture for the residents with proper seating. The facility does have a signal system. The facility does not have a pool/body of water. LIC 809C-continued The garage is attached to the house and can be accessed from the kitchen area. The garage has extra water and food for the residents. The washer and dryer are located in this area with more chemical and toxins locked and inaccessible to the residents. There is also extra freezers in this area with extra food. Bedrooms: There are seven (7) bedrooms and three (3) and 1/2 bathrooms. There are six (6) bedrooms for residents and one (1) for staff. One (1) of the bedrooms has a private bathroom. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry, and lightning. The bathrooms have proper toiletry and grab bars. The bathroom temperatures of the water are within regulations reading at 113–116-degree Fahrenheit. The dining/living room area has enough seating for the residents and the staff. There is a large television with cable and internet access. There is also a fireplace that is covered, inaccessible to the residents. There are cabinets in the hallway that have extra linen and incontinence supplies. The house temperature is at 74-degree Fahrenheit. The smoke detectors are located throughout the facility and are operable. There is one (1) carbon monoxide in the kitchen area. There are fire sprinklers throughout the house. There is another fire extinguisher at the entrance of the facility fully charged and dated 10/2025. Administrative: At the entrance of the facility on your right-hand side there is a YES sign, facility sketch, House Rules, Disaster Plan, Covid signs, Personal Rights, Medication Policy, Fire Safety Inspection, Rights of Resident Council, Personal Property Procedure, Theft and Loss Prevention Policy. The surety bond is current and expires 12/2025. Staff/Resident Files: LPA reviewed six (6) resident files and three (3) staff files. An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Nov 3, 2025

Type of visit: Case Management - Other

On 02/10/25, at 9:20am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, case management due to changes to facility sketch. The final approval was conducted by the Department of Building and Safety on 06/03/24. The facility now has seven (7) rooms instead of the original sketch of six (6) rooms. Six (6) bedrooms are for residents and one (1) bedroom is for staff. The Fire Inspection’s final approval was conducted on 01/15/25 with an updated LIC 850. A new LIC 200 was sent to the Community Care Licensing Department on 01/13/25 and the Pre-Inspection/Consultation Request of 1083.00 was paid on 10/18/24. All the documents have been paid and updated for the above facility. A copy of all the documents have been provided to the Licensee/Administrator, an exit interview was conducted, no citation(s) were issued and a copy of this report was given to the licensee/Administrator.the state’s words, verbatim · CDSS document, Feb 10, 2025

Type of visit: Required - 1 Year

On 10/01/24 at 9:25 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with administrator Nestor Tumaliuan and disclosed the purpose of the visit. LPA asked for the census, resident, and staff rosters. A physical tour was conducted at 11:15 AM and observed the following: The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The fire extinguisher is located against the wall on your left-hand side towards the staff room and garage area. It is fully charged. The expiration date is 11/2024. There is a telephone line on the counter in the kitchen. There is extra, food in the kitchen pantries. The medications are locked and inaccessible to the residents in one (1) of the top cabinets on your right-hand side. The knives are at the bottom of the sink on your left-side of one of the cabinets locked and inaccessible to the residents. The chemicals are on your right-hand side of the kitchen under the sink also locked and inaccessible to the residents. The first aid kit is in a cabinet area on your right side of the kitchen entrance. Outside/Backyard: The outside/backyard has furniture for the residents with proper seating. The facility does have a signal system. The facility does not have a pool/body of water. The garage is attached to the house and can be accessed from the kitchen area. The garage has extra water, incontinence, and ensure for the residents. The washer and dryer are located in this area. LIC 809C-continued Bedrooms: There are seven (7) bedrooms and four (4) bathrooms. There are six (6) of the bedrooms for residents and one (1) for staff. One (1) of the bedrooms has a private bathroom. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry, and lightning. The bathrooms have proper toiletry and grab bars. The bathroom temperatures of the water are within regulations reading at 110–115-degree Fahrenheit. The dining/living room area has enough seating for the residents and the staff. There is a large television with cable and internet access. There is also a fireplace that is covered, inaccessible to the residents. There are cabinets in the hallway that have extra linen and incontinence supplies. The house temperature is at 76-degree Fahrenheit. The smoke detectors are located throughout the facility and are operable. There is one (1) carbon monoxide in the kitchen area. There are fire sprinklers throughout the house. There is another fire extinguisher at the entrance of the facility. Administrative: There is an annual fee of $495.00 due in November. At the entrance of the facility on your right-hand side there is a YES sign, facility sketch, House Rules, Disaster Plan, Covid signs, Personal Rights, Medication Policy, Fire Safety Inspection, Rights of Resident Council, Personal Property Procedure, Theft and Loss Prevention Policy. The surety bond is current and expires 12/2024. An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Oct 1, 2024

Allegation investigated: Staff hit resident Staff handled resident in a rough manner

On 05/14/24, at 9:05am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Licensee Nestor Tumaliuan. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather additional documentation and deliver findings for this complaint. On 04/30/24, Licensing Program Analysts (LPAs) Gina Saucedo and Gary Tan initiated the investigation. On 04/30/24, the investigation consisted of four (4) attempted resident interviews and four (4) staff interviews. On 05/14/24, LPA Saucedo conducted a subsequent visit that consisted of obtaining the census, resident, staff roster and additional resident documentation. The licensee Nestor Tumaliuan met with LPA Saucedo to conduct the physical tour at 9:20am. LIC 9099C-continued Unsubstantiated This is an amended copy of the report previously issued on 05/14/2024. After review of this complaint, it was determined corrections to the verbiage was warranted. The complaint findings remain the same. Regarding the allegation: Staff hit resident. It is being alleged that the resident was hit by one (1) of the staff. LPA Saucedo attempted to interview four (4) out of four (4) residents but due to their diagnosis and non-verbal communication, LPA Saucedo did not obtain any information regarding the above allegation. LPA Gary Tan interviewed two (2) staff. S1 and S2 confirmed they were present the day of the allegation and that no staff hit a resident. S1 stated that the above facility belongs to them, and they would not jeopardize it. S2 confirmed that the licensee helps a lot with the residents and the day of the incident, S1 had to help because Resident #1 (R1)’s diaper and mat were wet. LPA Saucedo interviewed two (2) additional staff. S3 and S4, confirm that S1 helps with all the residents. Therefore, based on the LPA's record reviews, staff and resident attempted interviews the above allegation(s) is unsubstantiated at this time. Regarding the allegation: Staff handled resident in a rough manner. It Is being alleged that the resident was handled inappropriately by staff. LPA Saucedo attempted to interview four (4) out of four (4) residents but due to their diagnosis and non-verbal communication, LPA Saucedo did not obtain any information regarding the above incident. LPA Gary Tan interviewed two (2) staff. S1 & S2 confirmed no resident was handled inappropriately by staff. S2 stated that the day of the incident Resident #1 (R1) needed to be moved from the sofa and they needed help. S1 did state R1 needs a minimum of two (2) people to move R1 and that’s when they helped with R1. It took three (3) staff that day to move R1 from the sofa. The staff continued to say that S1 is gentle with the residents. S3 and S4 confirm that S1 helps with all the residents. Another staff-Staff #5 (S5) that helped R1 move from the sofa that day was interviewed via telephone by LPA Saucedo. Therefore, based on the LPA's record reviews, staff and resident attempted interviews the above allegation(s) above is unsubstantiated at this time. An exit interview was conducted, no citations were issued for above allegation(s), and a copy of this report was given to the Licensee.the state’s words, verbatim · CDSS document, May 14, 2024 · control 31-AS-20240423082632

Type of visit: Required - 1 Year

On 02/27/24 at 11:45 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with administrator Nestor Tumaliuan and disclosed the purpose of the visit. LPA asked for the census, resident, and staff rosters. A physical tour was conducted at 12:30 PM and observed the following: The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The fire extinguisher is located against the wall on your left-hand side towards the staff room and garage area. It is fully charged. The expiration date is 11/2024. There is a telephone line on the counter in the kitchen. There is extra, food in the kitchen pantries. The medications are locked and inaccessible to the residents in one of the top cabinets on your right-hand side. The knives are at the bottom of the sink on your left-side of one of the cabinets locked and inaccessible to the residents. The chemicals are on your right-hand side of the kitchen under the sink also locked and inaccessible to the residents. The first aid kit is in a cabinet area on your right side of the kitchen entrance. Outside/Backyard: The outside/backyard has furniture for the residents with proper seating. The facility does have a signal system. The facility does not have a pool/body of water. The garage is attached to the house and can be accessed from the kitchen area. The garage has extra water, incontinence, and ensure for the residents. The washer and dryer are located in this area. LIC 809C-continued Bedrooms: There are six (6) bedrooms and three and half (3 ½) bathrooms. There are five (5) of the bedrooms for residents and one (1) for staff. One (1) of the bedrooms has a private bathroom. The other three (3) are single, occupied. One (1) of the bedrooms is currently vacant. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry, and lightning. The bathrooms have proper toiletry and grab bars. The bathroom temperatures of the water are within regulations reading at 110–112-degree Fahrenheit. The dining/living room area has enough seating for the residents and the staff. There is a large television with cable and internet access. There is also a fireplace that is covered, inaccessible to the residents. There are cabinets in the hallway that have extra linen and incontinence supplies. The house temperature is at 71-degree Fahrenheit. The smoke detectors are located throughout the facility and are operable. There is one (1) carbon monoxide in the kitchen area. Administrative: There is no annual fee that is due right now. At the entrance of the facility on your right-hand side there is a YES sign, facility sketch, House Rules, Disaster Plan, Covid signs, Personal Rights, Medication Policy, Fire Safety Inspection, Rights of Resident Council, Personal Property Procedure, Theft and Loss Prevention Policy and Licensee Expiration dated 05/28/24. The surety bond was current. An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Feb 27, 2024