425850629-11-6-2025-29-AS-KBUY-DNRUA7-20251125142415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850629
Report Date: 11/06/2025
Date Signed: 11/06/2025 09:48:29 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2025 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20250812151548

FACILITY NAME:	JIREH SENIOR HOME CORPORATION		FACILITY NUMBER:	425850629
ADMINISTRATOR:	HERNANDEZ,PATRICIA		FACILITY TYPE:	740
ADDRESS:	2102 CALLE MIRASOL		TELEPHONE:	(805) 346-1519
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY:	6	CENSUS: 5	DATE:	11/06/2025
		UNANNOUNCED	TIME BEGAN:	08:26 AM
MET WITH:	Patricia Hernandez and Reyna Morales		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not administering medications as prescribed
Staff are not meeting residents personal hygiene needs
Staff are not meeting residents nutritional needs
Staff violate residents personal rights.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Licensee Patricia Hernandez and Back-up Administrator and explained the purpose of the visit. During the initial visit on 8/19/25 LPA toured the facility, interviewed back-up administrator and collected relative documents.

During the investigation, LPA conducted an initial visit, interviewed witnesses, and requested additional documentation.

On the allegation: Staff violate residents personal rights.
It was alleged that residents personal rights were being violated due to a male and female resident are sharing a room. Continue on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025

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 4

Control Number 29-AS-20250812151548

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: JIREH SENIOR HOME CORPORATION	FACILITY NUMBER: 425850629
	VISIT DATE: 11/06/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA toured resident room, there was a room divider, both residents are on Hospice and non-ambulatory. Facility has discussed this with family members and have received signed notices stating representatives are aware and approve of the sharing of the room with the opposite gender.

Based on interviews, records and observation, there is insufficient evidence to show that the resident personal rights are being violated. Therefore, at this time, the above allegation is found to be unsubstantiated.

On the allegation: Staff are not meeting residents nutritional needs

It was alleged that caregivers were instructed by Hospice to increase the thickening of liquids for Resident 1 (R1) to reduce the risk of choking, and to take additional time assisting Resident 2 (R2) during meals to encourage greater food intake. It was further alleged that staff remove food without providing adequate assistance.

According to physician documentation, R1 is on a pureed diet. Hospice notes indicate that liquids should be thickened to a “nectar” consistency using 1–2 scoops of thickening agent. The thickening agent is documented on R1’s Centrally Stored Medication and Destruction Record (CSMDR). During the visit, a properly labeled container of thickening agent was observed in the medication storage area. Interview with lead staff, they were able to explain R1’s orders, and preferences.

R2 has chopped diet. Hospice notes recommend offering preferred foods frequently and allowing additional time and assistance during meals. Dietician notes confirm that caregivers are following the established care plan for R2. Interview with lead staff, they were able to explain R2’s behaviors, and alternative methods, such as allowing R2 space, then returning to encourage R2 to eat if they had not. A new supportive spoon was introduced and note from hospice agency as of 9/10/25 state R2 is “reported to be doing better since [R2] has had a change in medications and has been able to feed [themselves] more frequently with the use of the adaptive spoon”

Based on observation, record reviews and interviews, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20250812151548

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: JIREH SENIOR HOME CORPORATION	FACILITY NUMBER: 425850629
	VISIT DATE: 11/06/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On the allegation: Staff are not administering medications as prescribed
It was alleged that staff are not administering PRN medications consistently and that when additional PRN was required from the Hospice Nurse, the medications could not be given as staff did not have access. Additionally, due to PRN not given as needed resident became agitated.

LPA confirmed during interviews that all staff have the code to the medication cabinet. All staff know they can call the administrator or lead staff to clarify any issues. PRN medications are available on all shifts for any staff to get if they need. All staff were confirmed to have medication training

Review of Patient Progress notes left during each visit for R2, reoccurring notes starting 4/28/25 about agitation, sundowning, combativeness, emotional, distressed, disoriented, LPA reviewed notes through October and note that around 7/13/25 notes regarding agitation stopped. Note from hospice agency as of 9/10/25 state R2 is “reported to be doing better since [R2] has had a change in medications and has been able to feed [themselves] more frequently with the use of the adaptive spoon” Medication change was lorasapam which is now s a PRN instead of 3 times a day, and a sleeping medication was introduced which provided R2 more rest.

Based on record review and interviews, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

On the allegation: Staff are not meeting residents personal hygiene needs

It was alleged that R2 was noted with food particles in facial hair, and same clothing on each visit.

During visit, LPA toured facility and observed residents. During visit R1 and R2 had family stop in. Family visited for a while and then pleasantly conversed with caregivers and then left. Residents were observed to be clean, with fresh clothing, there was no odors, or unkept clothing. LPA discussed hygiene and shower schedule with lead caregiver. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 29-AS-20250812151548

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: JIREH SENIOR HOME CORPORATION	FACILITY NUMBER: 425850629
	VISIT DATE: 11/06/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Discussion with Hospice Administration, review of notes for both residents do not detail any concerns regarding hygiene, or residents being neglected or unkept.

Based on observation, record review and interviews, while the allegation may have happened, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, copy of report given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4