345920069-7-27-2026-59-AS-LMUZ-DWHMYP-20260731100151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345920069
Report Date: 07/27/2026
Date Signed: 07/27/2026 12:37:38 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/24/2026 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20260724093224

FACILITY NAME:	JAZBA CARE STAMP MILL		FACILITY NUMBER:	345920069
ADMINISTRATOR:	VIPULANANDA, SANGEETHA		FACILITY TYPE:	740
ADDRESS:	2625 STAMP MILL COURT		TELEPHONE:	(916) 838-1457
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 5	DATE:	07/27/2026
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator, Shane Stumpf		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Staff mismanage resident's medication.
Facility is not sufficiently staffed to meet the needs of residents in care.
Staff do not provide a safe and comfortable environment for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 7/27/26 to do complaint investigation for above allegations. LPA was greeted by staff and staff called Administrator, Shane Stumpf who came to the facility after short while. LPA expained the purpose of today's visit.

The department conducted records review ,facility observations and interviews to investigate the complaint.

**Report continued on LIC9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

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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Control Number 59-AS-20260724093224

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JAZBA CARE STAMP MILL	FACILITY NUMBER: 345920069
	VISIT DATE: 07/27/2026

NARRATIVE

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**Report continued from 9099...

Allegation- Staff mismanage resident's medication. UNFOUNDED

Based on the information provided, the investigation conducted by the department involved facility observations, record review, and interviews with staff and residents to investigate the complaint allegation. During these interviews with two (2) staff and three (3) residents. It was revealed that the facility dispensed all residents' medications on time and administered them as scheduled. A review of the records for the month of July 2026, indicated that the facility maintained a proper logs for all medications in the centrally stored medication log, following physician's orders, and documenting them in the Medication Administration Record (MAR) without any errors. Staff interviews reflected that residents were given medications on time per their physician’s orders and there were no problems to address. Based on these findings, this allegation is considered UNFOUNDED.

Allegation- Facility is not sufficiently staffed to meet the needs of residents in care. UNFOUNDED

Record review and staff interviews indicated that there are 2 caregivers for day shift and 1 caregiver for night shift who works daily to meet residents needs. Interviews did not indicate any staffing concerns at the facility. Based on these findings, this allegation is considered UNFOUNDED.

Allegation- Staff do not provide a safe and comfortable environment for residents. UNFOUNDED

Based on the information provided, the investigation conducted by the department involved facility observations, record review, and interviews with staff and residents to investigate the complaint allegation. Residents interviews reflected that facility was providing safe and comfortable environment to them and there were no issues to address. Staff interviews reflected that there were no complaints in this area. Facility tour conducted on 7/27/27 indicated that facility was providing safe environment to residents per Regulations and there were no concerns. Based on these findings, this allegation is considered UNFOUNDED.

A finding that the allegations are Unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. A copy of this report has been provided to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

LIC9099 (FAS) - (06/04)

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