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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 06/05/2020
Date Signed: 06/05/2020 03:59:36 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/01/2020 and conducted by Evaluator See Moua
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200401151858
FACILITY NAME:JASMIN TERRACE AT BAKERSFIELDFACILITY NUMBER:
157208773
ADMINISTRATOR:KIRK, ELIZABETHFACILITY TYPE:
740
ADDRESS:5400 STINE ROADTELEPHONE:
(661) 398-8802
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:99CENSUS: 66DATE:
06/05/2020
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Elizabeth (Beth) Kirk, Administrator TIME COMPLETED:
10:53 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents needs not being met.
Facility is understaffed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) S. Moua called and spoke with Administrator Beth Kirk regarding the complaint allegations. Findings were delivered over the phone due to COVID 19 precaution guidelines.

LPA interviewed staff and resident at the facility. The resident referenced directly as not having her needs being met and that the facility is understaffed denied this happened. Resident confirmed that she is given showers. Records reviewed also support that resident is given showers according to the care plan. Reviewed of staff schedule (LIC 500) confirmed the facility is adequately staffed. Complaint is Unfounded.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda WhiteTELEPHONE: (559) 650-7908
LICENSING EVALUATOR NAME: See MouaTELEPHONE: (559) 580-6596
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2020
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/01/2020 and conducted by Evaluator See Moua
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200401151858

FACILITY NAME:JASMIN TERRACE AT BAKERSFIELDFACILITY NUMBER:
157208773
ADMINISTRATOR:KIRK, ELIZABETHFACILITY TYPE:
740
ADDRESS:5400 STINE ROADTELEPHONE:
(661) 398-8802
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:99CENSUS: 66DATE:
06/05/2020
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Elizabeth (Beth) Kirk, Administrator TIME COMPLETED:
10:53 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not providing medication as prescribed.
Facility not providing adequate food service.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) S. Moua called and spoke with Administrator Beth Kirk regarding the complaint allegations. Findings were delivered over the phone due to COVID 19 precaution guidelines.

Facility staff were interviewed and denied that residents missed their medications because the facility failed to refill residents' medications on time. Facility staff also denied that residents missed meals because the facility failed to make them. An adequate supply of perishable and non-perishable food were observed during an inspection tour. Review of medications and MARs reflects that residents #1 and #2 referenced directly in the complaint were given their medications as prescribed and did not miss any doses. There is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are Unsubstantiated. Exit Interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda WhiteTELEPHONE: (559) 650-7908
LICENSING EVALUATOR NAME: See MouaTELEPHONE: (559) 580-6596
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2