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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 11/22/2021
Date Signed: 11/22/2021 06:21:15 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
10/12/2021 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20211012141149
FACILITY NAME:JASMIN TERRACE AT BAKERSFIELDFACILITY NUMBER:
157208773
ADMINISTRATOR:ELECO, RAMONA D.FACILITY TYPE:
740
ADDRESS:5400 STINE ROADTELEPHONE:
(661) 398-8802
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:99CENSUS: 79DATE:
11/22/2021
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Ramona ElecoTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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9
Facility is in disrepair
Staff yells at resident
Facility did not provide transportation arrangements to resident in care
Centrally stored medications were made accessible to residents in care
Staff did not notify resident's physician of resident's change in condition
INVESTIGATION FINDINGS:
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An unannounced Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg & Licensing Program Manager (LPM) See Moua. LPA & LPM met with Administrator (Admin) Ramona Eleco & stated purpose of visit.

The Department conducted interviews with residents & staff, toured the facility & reviewed records. Based on observations the sinks & showers in resident's room were not leaking & had hot water. The Med room was observed locked with a Med Tech & residents interviewed confirmed that staff do not yell at them & transportation arrangements are provided. The Admin stated that resident's physician's are notified of changes immediately. The allegations are Unsubstantiated.

No deficiencies. Exit interview conducted with Admin.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
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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