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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604815
Report Date: 10/01/2026
Date Signed: 10/01/2026 03:55:17 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/24/2026 and conducted by Evaluator Liliana Silveira
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20260924104034
FACILITY NAME:JACOB HEALTH CARE CENTERFACILITY NUMBER:
374604815
ADMINISTRATOR:CRUZ, JOSEPHFACILITY TYPE:
740
ADDRESS:4075 54TH STREETTELEPHONE:
(619) 582-5168
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:40CENSUS: 40DATE:
10/01/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrative Assistant Jacqueline OrtegaTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure the resident was kept clean.
Staff did not meet the resident's mobility care needs.
Staff did not allow the resident to have access to leisure activities.
Staff did not follow the resident's care plan meeting requirements.
Staff disclosed the resident's confidential information to unauthorized individuals.
Staff did not safeguard the resident's mail.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to conduct a complaint investigation. LPA was granted entry by Wendolyn Olea. LPA met with the Administrative Assistant for the Assisted Living (AL) Department, Jacqueline Ortega, soon after.

During the visit, LPA conducted an interview with the Administrative Assistant, as well as with an outside source, and reviewed facility records. The individual mentioned in the complaint, Resident #1 (R1), was not found on the AL roster, but was located on the SNF roster. The SNF department falls under the jurisdiction of the Department of Public Health.

The Department has found that the complaint allegations listed above are unfounded due to R1 not residing in the Assisted Living Department of the facility. Unfounded means that the allegations are false, could not have happened and/or are without a reasonable basis. An exit interview was conducted with Jacqueline and a copy of this report, along with the Licensee/Appeal rights (LIC9058 03/22), were provided via email. Signature below is confirmation that the documents were received.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
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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