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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005477
Report Date: 06/09/2026
Date Signed: 06/10/2026 09:01:08 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/02/2026 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20260602081450
FACILITY NAME:JC HOME FOR SENIORS-CAREFACILITY NUMBER:
306005477
ADMINISTRATOR:PARUNGAO, MARIA EFACILITY TYPE:
740
ADDRESS:15332 SHASTA LANETELEPHONE:
(714) 622-5118
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: DATE:
06/09/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jay Parungao and Administrator Maria Emeterio TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility had missing and/or inoperable smoke alarms
INVESTIGATION FINDINGS:
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On June 9, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for an initial complaint investigation visit into the above allegation. LPA was greeted and granted entry after stating the purpose of the visit to staff. The License Jay Parungao and Administrator Maria Emeterio were present and assisted with the investigation.

The following was determined:
Regarding the allegation, Facility had missing and/or inoperable smoke alarms, it was alleged that two fire alarms were missing or nonoperational. During the visit, LPA conducted a tour of the interior and exterior physical plant with staff and reviewed the facility sketch. Fire alarms in all common areas and bedrooms were tested. LPA observed one nonoperational fire alarm in Resident Bedroom #4 and one missing fire alarm in the Family Room. A deficiency is being cited.

CONTINUE TO LIC9099-C........
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
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 22-AS-20260602081450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: JC HOME FOR SENIORS-CARE
FACILITY NUMBER: 306005477
VISIT DATE: 06/09/2026
NARRATIVE
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Based on record review and observations made during the investigation, the preponderance of evidence
standard has been met for allegation: Facility had missing and/or inoperable smoke alarms is deemed SUBSTANTIATED.

A deficiency is being cited as per the California Code of Regulations, Title 22, Division 6, Chapter 8. Civil
Penalty Assessed.

An exit interview was conducted with License Jay Parungao and Administrator Maria Emeterio, and a copy of this report, LIC9099D, and appeal rights were provided at the end of the visit.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260602081450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: JC HOME FOR SENIORS-CARE
FACILITY NUMBER: 306005477
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/10/2026
Section Cited
CCR
87203
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87203 Fire Safety:All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidence by:
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During the visit, Licensee replaced the fire alarm battery in Resident Bedroom #4 and installed a new fire alarm in the Resident Family Room. Both were observed operational before exit.
Deficiency cleared during visit.
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Based on observation and record review, 2 out of 9 smoke alarms were missing/non-operational, which poses an immediate risk to the health and safety of residents in care. LPA observed a nonoperational fire alarm in resident Bedroom #4 and a missing fire alarm in the common Family Room.
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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.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3