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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803977
Report Date: 07/29/2025
Date Signed: 07/29/2025 03:10:57 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/19/2025 and conducted by Evaluator Anthony Loera
COMPLAINT CONTROL NUMBER: 21-AS-20250619153050
FACILITY NAME:JPS HOME CARE SERVICESFACILITY NUMBER:
486803977
ADMINISTRATOR:JULLY CARTELFACILITY TYPE:
740
ADDRESS:441 NORTH CAMINO ALTOTELEPHONE:
(707) 655-2264
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:6CENSUS: 5DATE:
07/29/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Olivia Pangilinen, CaregiverTIME COMPLETED:
03:25 PM
ALLEGATION(S):
1
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9
Staff failed to safeguard residents' cash resources
INVESTIGATION FINDINGS:
1
2
3
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5
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7
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9
10
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12
13
Licensing Program Analyst (LPA) Loera arrived unannounced and met with Olivia Pangilinen, Caregiver to deliver findings of a complaint investigation. During the course of this investigation, documents were reviewed, observations made, and interviews conducted from outside parties.

Complaint alleges staff failed to safeguard residents' cash resources.
During the course of the investigation, LPA was informed resident (R1) receives checks from an outside agency that is provided and written to the facility. It was reported that R1 was written two (2) separate checks for $200.00 on May 20, 2025 and One (1) check in the amount of $500.00 written on May 28, 2025. Complaint alleges (R1) did not receive the check written on May 28, 2025. LPA was provided with conflicting information about funds for both checks being written, as to who wrote them and when they were cashed. Interviews conducted with all parties revealed (R1) did receive their funds in the full amount.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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