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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601129
Report Date: 12/09/2024
Date Signed: 12/09/2024 10:36:45 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/31/2024 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20241031162122
FACILITY NAME:JLA HEALTHCARE SERVICES LLCFACILITY NUMBER:
415601129
ADMINISTRATOR:LEONARD, JEROMEFACILITY TYPE:
740
ADDRESS:1185 ACACIA STREETTELEPHONE:
(650) 477-2857
CITY:MONTARASTATE: CAZIP CODE:
94037
CAPACITY:24CENSUS: 21DATE:
12/09/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Loi BustamanteTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Facility is in financial distress.
INVESTIGATION FINDINGS:
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On December 9, 2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the investigation findings. Upon entry, LPA met with med tech, Hurry Valdez and LPA explained the purpose of the visit. The Administrator, Loi Bustamante arrived shortly thereafter and LPA explained the purpose of the visit.

Regarding to the allegation of facility is in financial distress, there is no additional information forthcoming from the reporting party, however, during the initial reporting, the reporting party stated that they received validated information that the facility and its licensees recently filed Bankruptcy and based on foregoing, they could say that the facility and its licensees are now in a big financial crisis and distress.

As part of the investigation, LPA interviewed the administrator/licensee, facility staff, residents and responsible party.

The administrator/licensee acknowledged that the facility filed for bankruptcy but denied the allegation and stated that the facility is not in financial distress and the bankruptcy was filed to resolve a pending litigation that was filed many years ago and it did not have anything to do with the facility's operation/ expenses.


Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
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 2
Control Number 14-AS-20241031162122
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: JLA HEALTHCARE SERVICES LLC
FACILITY NUMBER: 415601129
VISIT DATE: 12/09/2024
NARRATIVE
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LPA interviewed four staff members and all them stated that they were informed of the bankruptcy by the administrator and they did not experience any changes with caring for the residents and their pay reminded accurate and on time.

LPA interviewed two residents and both of them reported that they were being well cared for and they did not notice any changes with the services that they were receiving.

LPA interviewed a responsible party who visited the facility on a regular basis and he/she did not notice any changes with the level of care that his/her loved one was receiving due to the bankruptcy.

Based on observation and interviews, this allegation is deemed to be unfounded.

The agency has investigated the allegation and we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

This report is reviewed and discussed with the administrator. A copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2