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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 032701408
Report Date: 12/19/2025
Date Signed: 12/19/2025 12:56:26 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
12/14/2025 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20251214231119
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: 61DATE:
12/19/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Nataliya Regan, Co-AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff are not properly advertising their license number.
Staff are not properly posting the notifications required by licensing.
INVESTIGATION FINDINGS:
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On 12/19/2025, Licensing Program Analyst, Arvin Villanueva (LPA), conducted an unannounced complaint investigation visit to the facility to investigate the allegations noted above.
In this visit, LPA conducted a facility tour, interviewed staff and resident, and reviewed records and the facility’s website.

The investigation into the allegation that staff are not properly advertising their license number consisted of facility observation, interviews and review of facility’s website.
During the facility tour, LPA observed multiple postings throughout the building. The Facility License was observed posted on the wall behind the reception office. This LPA stood in front of the reception desk, where residents and guests would stand. From this perspective, LPA can see the Facility License, but it is located far enough that the facility number is not legible. Note that this LPA does not wear reading glasses and has normal vision of about 20/20.
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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
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-20251214231119
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: 12/19/2025
NARRATIVE
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Interviews with staff confirm that the facility website does not include the Facility’s license number. LPA reviewed the facility’s website, https://jacksonhillsassisted.com/, and confirmed that the facility license number is not displayed on any of the webpages Based on the information obtained through observation, interviews, and website review, the allegation that staff are not properly advertising their license number is SUBSTANTIATED.

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The investigation into the allegation that staff are not properly posting the notifications required by licensing consisted of facility tour and interviews with staff and residents.

During the facility tour, LPA observed several required postings throughout the building. The Personal Rights poster was observed in the hallway immediately after the entrance/lobby area, across from the reception and medication room, leading toward the activity area. The facility license was observed posted on the wall behind the reception office. LPA also observed an Ombudsman poster in the hallway near the entrance/lobby area and another Ombudsman poster posted in the hallway leading to the dining area near the kitchen.


LPA observed the Rights to Resident Council posted on a cork board in the activity area. Activity calendars were posted at the entrance/lobby area and in the activity area. The Administrator stated that each resident receives a copy of the activity calendar monthly, and newsletters are provided to family members. Paper copies of newsletters are also available in the lobby for residents to read. LPA additionally observed “No Smoking” signage due to oxygen use, as well as Oxygen Use signage posted at the doors of residents using oxygen.
However, LPA did not observe the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) posted anywhere in the facility during the visit.
Interviews with staff confirms that the RCFE Complaint Poster is not currently posted anywhere in the building. Interview with a resident confirmed they know the location of the Ombudsman poster but did not reference seeing the RCFE Complaint Poster.

Based on the information obtained through observation and interviews, the allegation that staff are not properly posting the notifications required by licensing is SUBSTANTIATED.

A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Nataliya Regan and a copy of this report and appeal rights were provided.

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

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20251214231119
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: 12/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2025
Section Cited
CCR
87206(a)
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In accordance with Health and Safety Code Sections 1569.68 and 1569.681, licensees shall reveal each facility license number in all public advertisements, including Internet, or correspondence.
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Per discussion, the licensee will include the facility license number in the facility's website.
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This requirement is not met as evidenced by:
Base on observation, interviews and review of facility's website, the licensee did not ensure their facility license number was included in their website. This poses a potential health, safety, and personal rights risks to persons in care.
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Photo of the website showing the license number will be submitted to the Department by POC due date.
Type B
12/31/2025
Section Cited
CCR
87468(c)(2)(A)
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Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website.
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Per discussion, Administrator agreed that photo of the require poster, posted on the facility wall, will be submitted to the Department by POC due date.
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This requirement is not met as evidenced by:
Through observation and interviews, the licensee did not ensure their complaint poster is posted at all times. This poses a potential health, safety, and 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: 12/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3