032701408-9-11-2026-27-AS-LRIS-DY7MUU-20260923095542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 032701408
Report Date: 09/11/2026
Date Signed: 09/11/2026 10:40:32 AM

Unsubstantiated

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
05/08/2026 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20260508151510

FACILITY NAME:	JACKSON HILLS ASSISTED LIVING LLC		FACILITY NUMBER:	032701408
ADMINISTRATOR:	JORDAN, JAMES		FACILITY TYPE:	740
ADDRESS:	223 NEW YORK RANCH ROAD		TELEPHONE:	(916) 212-0275
CITY:	JACKSON	STATE: CA	ZIP CODE:	95642
CAPACITY:	70	CENSUS: 58	DATE:	09/11/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Nataliya Regan, Designee		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident suffered a fall resulting in hospitalization and death.

INVESTIGATION FINDINGS:

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

On 09/11/26, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to deliver the findings of the investigation into the above allegation. LPA identified herself upon arrival, stated the purpose of the visit and asked to speak with the Designated Facility Administrator/ Executive Director (ED). LPA met with Designee, Nataliya Regan, and a brief interview followed where Regan informed this LPA that they will be moving out of the country at the end of the month, and the Care Coordinator will be the new Designee.

Regarding the allegation: Neglect /Lack of Care and Supervision: Resident suffered a fall resulting in hospitalization and death.

The Department learned that on 12/23/25, a resident (R1) fell in the facility’s dining room and subsequently passed away from their injuries on 12/26/2025. Two staff, S1 and S2 reported being in the immediate area at the time of the fall, but neither were close enough to prevent the fall. R1 was a fall risk based on a history of falls at other facilities; however, R1 had not previously fallen at Jackson Hill

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026

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 2

Control Number 27-AS-20260508151510

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: 09/11/2026

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

Assisted Living. R1 mostly cared for their own needs independently and was able to transfer and walk about the facility on their own, with the assistance of a walker. R1's spouse frequently visited R1 and had no concerns about staff supervision or quality of care. The spouse confirmed that R1 required no assistance with transfers or walking.

The Sacramento County Coroner’s Office found no suspicious circumstances and had no concerns of foul play. Though staffing was of slight concern for some staff, there is insufficient evidence to show that neglect/lack of care and supervision contributed to Billy’s fall and subsequent death.

The standard for the preponderance of evidence was not met and the Department found the above allegation UNSUBSTANTIATED. A finding of unsubstantiated means that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. A case management visit will be conducted following this meeting to address concerns regarding staffingand other observations made by this LPA. .

According to the California Code of Regulations, Title 22, no deficiencies were observed of cited during today's visit , a copy of this report was provided, along with APPEAL RIGHTS and an exit interview was conducted with the Administrator.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2