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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005502
Report Date: 01/23/2025
Date Signed: 01/23/2025 12:20:22 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250115161832
FACILITY NAME:JEWEL HOMECARE 2FACILITY NUMBER:
306005502
ADMINISTRATOR:PAO, WESLEYFACILITY TYPE:
740
ADDRESS:20152 RIVERSIDE DRTELEPHONE:
(424) 270-4452
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY:6CENSUS: 4DATE:
01/23/2025
UNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Jehla Rose Gabriel, AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff do not ensure snacks are made available for residents in care
Staff do not ensure residents are provided adequate size meal portions
Staff do not ensure residents door handle is in good repair
Licensee did not adequately safeguard residents personal belongings
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the four allegations listed above. LPA was greeted and granted entry by administrator Jehla Rose Gabriel after introducing himself and stating the purpose of the visit. Administrator was also provided with the allegations investigated.

During the present visit, LPA accompanied by facility staff conducted a tour of the facility's physical plant. Three out of the four residents are present on the premises and were interviewed during the visit. One additional resident is hospitalized as reported to the Department by licensee on January 21, 2025. Resident records for all four current residents were requested, obtained and reviewed during the visit. Additional witness and staff interviews conducted by telephone ahead of the inspection.

CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
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 2
Control Number 22-AS-20250115161832
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: JEWEL HOMECARE 2
FACILITY NUMBER: 306005502
VISIT DATE: 01/23/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Staff do not ensure snacks are made available for residents in care, the following has been concluded: During the tour of the physical plant, LPA reviewed the ample food supply available for use by residents, as well as meal menus. Three resident interviewed confirmed the availability of snacks upon demand and the fact that such snacks are adequate to their preferences.

Regarding the allegation that Staff do not ensure residents are provided adequate size meal portions, the following has been concluded: The quantity of perishable and non-perishable food items observed during the facility visit is consistent with adequate meal sizes being provided. Three residents interviewed confirmed that they were satisfied with the quantity, quality and variety of food available. Staff and residents interviews also confirmed that menus are modified to accommodate food preferences and specialized diets.

Regarding the allegation that Staff do not ensure residents door handle is in good repair, the following has been concluded. Door knobs on each of the four bedrooms are verified to be operational and in good repair. One doorknob was reported to have been damaged as a result of a resident's behavioral expression prior to the visit, but is confirmed to have been replaced and repaired adequately during the facility visit.

Regarding the allegation that Licensee did not adequately safeguard residents personal belongings, the following has been concluded: Two out of three residents interviewed denied having issues with theft and/or loss of personal items and valuables during their period of admission. A third resident indicated that they had no overall issues aside from instances of gathering "fruit and vegetables". Resident assessment indicates a Pika diagnosis and facility staff has been reporting to the Department via Special Incident Report forms removals of fermenting food items from the resident's bedroom prior to the visit being conducted. Resident was documented to be homeless prior to admission and did not put any belongings into safeguarding with the facility upon admission.

Based on the evidence gathered during the present facility visit, the four allegations above are determined to be Unfounded, meaning that the allegations are false, could not have happened and/or are without a reasonable basis. The Department has investigated this complaint.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2