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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011441040
Report Date: 03/04/2026
Date Signed: 03/04/2026 02:25:01 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/23/2026 and conducted by Evaluator Yasamin Brown
COMPLAINT CONTROL NUMBER: 15-AS-20260123124712
FACILITY NAME:JONES REST HOMEFACILITY NUMBER:
011441040
ADMINISTRATOR:CHARLES W DRAKEFACILITY TYPE:
740
ADDRESS:524 CALLAN AVENUETELEPHONE:
(510) 483-6200
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:31CENSUS: 10DATE:
03/04/2026
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lisa Rodriguez, Director of Nursing TIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handled resident in a rough manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/4/2026 at 9:45 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegations above. LPA met with Lisa Rodriguez, Director of Nursing and informed her the reason for visit.

During the course of investigation, LPA interviewed staff and residents. LPA obtained the following documents for R1, R2 and R3: Face Sheet, LIC602 (Medical Assessment), Appraisal Needs and Services Plan, Care Notes, Body/shower check log, the staff schedule, the licensed nurse staff schedule.

Continued on LIC9099-C.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
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 15-AS-20260123124712
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: JONES REST HOME
FACILITY NUMBER: 011441040
VISIT DATE: 03/04/2026
NARRATIVE
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32
Continued from LIC9099.

Allegation: Staff handled resident in a rough manner
Finding: Unsubstantiated

Interview with residents revealed that they feel safe and comfortable living at the facility. Interview with residents reveal that they have not experienced any staff members handling them in a rough manner. R1 stated that they are very sensitive when being touched but the staff make sure they are well taken care of. R1 stated that if the residents ask for assistance, there is always a staff there to help. Interview with staff revealed that they have not heard or witnessed any staff members handling the residents in a rough manner. Interview with staff revealed that staff accommodate the needs of the residents.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies are being cited on this date.

Exit interview conducted with Lisa and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2