306006303-12-17-2025-22-AS-APAO-DPHHVJ-20251219053201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006303
Report Date: 12/17/2025
Date Signed: 12/17/2025 03:47:49 PM

Unsubstantiated

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
12/12/2025 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20251212145050

FACILITY NAME:	CARE SAINT JACOB		FACILITY NUMBER:	306006303
ADMINISTRATOR:	JULIE G CORNEJO		FACILITY TYPE:	740
ADDRESS:	4110 E JORDAN AVE		TELEPHONE:	(714) 289-1946
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	6	CENSUS: 6	DATE:	12/17/2025
		UNANNOUNCED	TIME BEGAN:	10:37 AM
MET WITH:	Joselene Poy Lorenzo-Caregiver, Julie Cornejo-Administrator		TIME COMPLETED:	04:02 PM

ALLEGATION(S):

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Staff do not ensure there is enough food to meet the needs of residents
The facility is understaffed to meet the resident needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegations and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Caregiver Joselene Poy Lorenzo. LPA explained the reason for the visit. Administrator (AD) Julie Cornejo arrived shortly after.

This agency has investigated the complaint alleging that staff do not ensure there is enough food to meet the needs of residents. Regarding the allegation, the following was revealed: During the course of the interviews five of six individuals interviewed denied the allegation. During the investigation LPA reviewed the Care Saint Jacob food menu. Per food menu, the residents are offered a different meal for breakfast, lunch and dinner throughout the week. Per food menu, the residents are provided snacks in between meals. During the course of the interviews with residents, Resident 1 (R1) reported that he gets a meal for breakfast, lunch and dinner. Per R2, staff give the residents enough food and stated that she gets three meals per day.
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025

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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Control Number 22-AS-20251212145050

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: CARE SAINT JACOB	FACILITY NUMBER: 306006303
	VISIT DATE: 12/17/2025

NARRATIVE

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R3 reported that he gets plenty of food and stated that staff go out of their way with the meals. During the course of the interviews with staff, Staff 1 (S1) reported that they have enough food to meet the resident needs and stated that no resident has complained about not getting enough food. Per S2, the residents get three meals per day plus snacks. S2 stated that the residents can get seconds or can substitute an item they do not like.

Regarding the allegation that the facility is understaffed to meet the resident needs, the following was revealed: During the investigation LPA reviewed the Personnel Report (LIC500) dated December 1, 2025. Per Personnel Report there are two caregiver for the day shift from 7:00 a.m. to 7:00 p.m. and one caregiver for the night shift from 7:00 p.m. to 7:00 a.m. During the initial visit LPA observed two caregivers on duty for six residents in care. During the course of the interviews with residents, R1-R3 reported that they have enough staff to care for the residents and/or stated that staff helps within a reasonable time. During the course of the interviews with staff, S1 reported that they have enough staff to care for the residents. Per S2, they have enough staff to care for the residents and get their job done.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.
LPA conducted an exit interview with facility representative Poy Lorenzo, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025

LIC9099 (FAS) - (06/04)

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