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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700264
Report Date: 02/25/2026
Date Signed: 02/25/2026 07:23:01 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
11/13/2025 and conducted by Evaluator Noel Wolf Petersen
COMPLAINT CONTROL NUMBER: 27-AS-20251113172249
FACILITY NAME:JEWELL HOME CAREFACILITY NUMBER:
392700264
ADMINISTRATOR:RALH, MONICAFACILITY TYPE:
740
ADDRESS:1141 S. VAN BUREN STREETTELEPHONE:
(209) 323-4972
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: DATE:
02/25/2026
UNANNOUNCEDTIME BEGAN:
05:58 PM
MET WITH:TIME COMPLETED:
07:30 PM
ALLEGATION(S):
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Resident sustained unexplained injuries
INVESTIGATION FINDINGS:
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On 2/25/26 at 6:00pm, LPA Wolf Petersen arrived to deliver the findings of a complaint. LPA met with administrator Monica Plowden, by phone to explain the findings of a departmental report concerning the above allegation(s).

By interview it was learned that on 10/23/25, R1 had a bathing visit from an aide who provided a statement that they did not observe bruising at that time, a follow up visit occurred on 10/28/25, in which the aide observed bruises on the lower right and left sides of her face, right neck, upper right and left arm, right forearm, and lower leg left. 2 staff of the facility and the administrator provided statements that they did not know the origin of the bruises. S2 noticed a bruise on R1's face on 10/27/25, which was not present on 10/24/25. S3 was the only staff working 10/25/25 and 10/26/25, and provided a statement denying unintentionally or intentionally causing r1's bruising. Additionally, S3 reported that they failed to notify the Administrator of the bruising, stating "they were waiting for hospice to come by to report it".
Continued on C-page
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
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-20251113172249
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: JEWELL HOME CARE
FACILITY NUMBER: 392700264
VISIT DATE: 02/25/2026
NARRATIVE
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According to interviews with both staff and the Administrator, the staff are not present when the residents are bathed by an outside agency. According to interview with S3, the believed that the aide caused the bruising but failed to report.

A record review of R1's hospital visit 10/28/25 in relation to the bruising, noted the bruising appeared to be in a grabbing pattern to R1's right and left upper extremities at distal biceps, bilateral shins, and upper chest, secondary to handling r1 for care. R1 was not on any medications that would cause bruising.

Observations of R1 detail they are bedbound and depend on caregivers for all activity's of daily living. R1 is nonverbal and its expression imposed difficulty on explaining how they sustained the injuries.

Based on the departments observations and interviews and record review which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. This incident is currently under review and a future civil penalty may apply based on 1569.49(f) H&S. Failure to correct the deficiencies may also result in civil penalties. Exit interview conducted and appeal rights provided.

A copy of the report was read, was given to the administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20251113172249
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: JEWELL HOME CARE
FACILITY NUMBER: 392700264
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2026
Section Cited
CCR
87464(d)
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87464 (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources.
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No imediate POC: the resident has alreaty been removed from the facility. Licensee should provide training on the facilities care and supervision policies annually. Licensee will update their Plan of Operation to address this in detail by 3/6/26. Call the LPA in advance of this date if there is more time needed.
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This requirement was not met as evidenced by: R1 was observed to have significant bruising on the body, presumably from either the Aide providing baths unsupervised by the facility staff, or by personal care being provided to a bedridden person with inadequate staffing to provide the care necessary to safely meet the needs of R1.In either instance, the facility failed to provide the necessary care which poses an immediate risk to the health and safety to clients 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: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3