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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011441040
Report Date: 08/13/2026
Date Signed: 08/13/2026 01:11:51 PM

Substantiated


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
08/10/2026 and conducted by Evaluator Yasamin Brown
COMPLAINT CONTROL NUMBER: 15-AS-20260810102419
FACILITY NAME:JONES REST HOMEFACILITY NUMBER:
011441040
ADMINISTRATOR:DELLA DE LEONFACILITY TYPE:
740
ADDRESS:524 CALLAN AVENUETELEPHONE:
(510) 483-6200
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:31CENSUS: 10DATE:
08/13/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Della DeLeon, Administrator TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility does not have adequate lighting.
INVESTIGATION FINDINGS:
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On 8/13/2026 at 9:00 am, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings for the allegation above. LPA met with Mary Joy Sabisor, Patient Coordinator and explained the purpose of the visit. Administrator Della Deleon arrived around shortly after around 10:15 am.

During the investigation, LPA toured the facility including bedrooms, bathrooms and outside area. LPA conducted interviews with three (3) staff and four (4) residents.

Allegation: Facility does not have adequate lighting.
Finding: Substantiated

Continued on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
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 3
Control Number 15-AS-20260810102419
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: 08/13/2026
NARRATIVE
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Continued from LIC9099.

During Investigation, LPA toured the facilities outdoor path ways and observed that the facility did not have operable light fixtures where residents can exit and enter from. LPA observed certain light fixtures along the facility that did not have working light bulbs. R1 stated that they have doctor appointments that they attend in the morning and the facility does not have working light fixtures along the pathway where their transportation picks them up. R3 stated that the facility does not have sufficient lighting along certain pathways of the facility. S1 and S2 stated that they were made aware of the insufficient lighting along the pathways and thought that they had been replaced.

Based on LPA’s interviews and observations, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted. A copy of the appeal rights and this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20260810102419
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2026
Section Cited
CCR
87307(d)(4)
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(d) The following space and safety provisions shall apply to all facilities: (4) Stairways, inclines, ramps and open porches...well-lighted.

This requirement is not met as evidenced by:
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By POC date, the Administrator agrees to replace the broken light bulb and add two light fixtures near the ramp/open porch where residents reside and send photo proof to CCLD.
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Based on observation the licensee did not comply with the section cited above by not having adequate lighting near the ramps and open porches that are accessible to residents which poses a potential safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3