374604837-1-15-2026-08-AS-SJAB-DQU2CC-20260130161632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604837
Report Date: 01/15/2026
Date Signed: 01/15/2026 05:49:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2026 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20260113083722

FACILITY NAME:	PANCHITO'S PLACE		FACILITY NUMBER:	374604837
ADMINISTRATOR:	JACKSON, JEFF		FACILITY TYPE:	735
ADDRESS:	117 OXFORD ST.		TELEPHONE:	(619) 349-2058
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91911
CAPACITY:	4	CENSUS: 4	DATE:	01/15/2026
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Caregiver Newell LaPierre, Licensee/Administrator Jeff Jackson, and House Manager Gabriel Salom		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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-Licensee did not allow client to receive their visitor.
-Licensee did not arrange needed medical care for client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Newell LaPierre. LPA then met with Licensee/Administrator Jeff Jackson and House Manager Gabriel Salom, who arrived later during the visit.

The Complainant alleged that License did not allow Client #1 (C1) to receive their visitor [Person #1 (P1)] at the facility, and the Licensee did not arrange needed medical care for C1. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of C1, other clients in care, and pertinent facility staff and outside sources. The Department also reviewed relevant care records and electronic correspondence.

[CONTINUED ON LIC 9099-C, 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

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 08-AS-20260113083722

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PANCHITO'S PLACE	FACILITY NUMBER: 374604837
	VISIT DATE: 01/15/2026

NARRATIVE

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[CONTINUED FROM LIC 9099]

The Complainant alleged that on 01/06/2026, Licensee did not allow C1 to receive their outside visitor, P1. However, interviews showed that P1 did not physically come to facility premises seeking to enter or meet with C1, either on that day or any other day. Interviews of Licensee and P1, corroborated by electronic correspondence, aligned to show: Around this time, Licensee and P1 communicated via phone. Licensee did not prohibit P1 from visiting C1 at the facility. Rather, P1 changed their own mind and decided not to visit C1. P1 said they did not believe C1’s visitation rights were violated. P1 affirmed that Licensee was cordial/professional with them. LPA interviewed 3 of 3 other clients in care, each of whom denied Licensee’s staff ever interfering with their own ability to receive visitors.

The Complainant alleged that during early January 2026, C1 had self-inflicted cigarette burns on their left forearm and hand, and that Licensee did not arrange timely medical care for these. They alleged that C1 had a productive cough, and that Licensee did not take C1 to urgent care, as C1 requested. They also alleged that C1 requested to have a therapist for their mental health needs, and that Licensee did not follow up on this.

Interviews of C1 and staff aligned to show: Licensee’s staff quickly discovered/identified C1’s cigarette burns and timely contacted C1’s nurse practitioner (NP), who worked under C1’s primary care physician (PCP). Licensee’s staff sent the NP photographs of the affected areas on C1’s arm and hand, which the NP reviewed. The PCP/NP advised that based on these photographs, C1 did not require urgent care or hospital attention that day. They further instructed facility staff to send them updated photographs three (3) days later, which Licensee’s staff indeed completed. Upon receipt of the second round of photos, the PCP prescribed a 10-day antibiotic for C1, which facility staff gave to C1 as prescribed. The PCP and NP then both visited C1 at the facility at the conclusion of the antibiotic treatment, verifying that C1’s arm and hand were continuing to heal well. C1 was then prescribed a topical ointment to continue applying. During his own 01/15/2026 visit, LPA observed that C1’s burns were closed and scabbed over, and that this ointment was on top of said scabs, as expected.

[CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20260113083722

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PANCHITO'S PLACE	FACILITY NUMBER: 374604837
	VISIT DATE: 01/15/2026

NARRATIVE

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[CONTINUED FROM LIC 9099-C, 1 of 2]

Interviews of C1 and staff aligned to show: About a week before the complaint was filed, C1 developed a productive cough, involving some phlegm and trace amounts of blood. However, C1 did not have a fever, wheezing, or labored breathing. Licensee’s staff contacted the office of C1’s NP/PCP via phone, they continued to observe C1 throughout the day, and they measured C1’s vital signs. Based on their observations, Licensee’s staff did not believe C1’s symptoms warranted Urgent Care or Hospital Care. C1 themselves had declined such care. The next day, C1’s NP arrived at the facility to check on C1. During his owb 01/15/2026 visit, LPA observed C1’s cough was almost fully resolved; C1 was able to speak clearly and easily, and C1 was walking throughout the facility without difficulty. Per LPA’s interviews 3 of 3 other clients in care; each denied ever needing Urgent Care or Hospital attention for which Licensee did not timely respond.

Interviews of C1 and staff aligned to show: Since time of move in, C1 has had available to them an assigned psychiatrist and an assigned behavioral consultant/specialist. Prior to the filing of this complaint (it was received at CCLD on 01/13/2026), C1 had received visits from both professionals. It was during a care conference meeting that same day [involving C1, C1’s responsible person, San Diego Regional Center (SDRC) personnel, and facility management] that C1 first expressed an interest in securing a mental health therapist for themselves. Facility managers and SDRC personnel were encouraging about this goal. Not enough time has elapsed from the date of Licensee’s constructive notice to the filing of this complaint to support the claim that Licensee refused to support C1 with finding a mental health therapist. Additionally, C1’s funding is controlled by SDRC; the responsibility for finding C1 a therapist ultimately rests more with SDRC than it does with Licensee.

Based on records and interviews, a preponderance of evidence does not exist to show that License did not allow a client to receive their visitor at the facility, or that Licensee did not arrange needed medical care for a client. Both allegations are therefore Unsubstantiated, and no deficiencies were cited for them.

An exit interview was conducted with Licensee/Administrator Jeff Jackson and House Manager Gabriel Salom, to whom copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC9099 (FAS) - (06/04)

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