157208773-12-20-2021-24-AS-SPIY-C9ZTD9-20211224133757

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 12/20/2021
Date Signed: 12/20/2021 06:08:32 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
10/11/2021 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20211011111843

FACILITY NAME:	JASMIN TERRACE AT BAKERSFIELD		FACILITY NUMBER:	157208773
ADMINISTRATOR:	ELECO, RAMONA D.		FACILITY TYPE:	740
ADDRESS:	5400 STINE ROAD		TELEPHONE:	(661) 398-8802
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93313
CAPACITY:	99	CENSUS: 78	DATE:	12/20/2021
		UNANNOUNCED	TIME BEGAN:	05:15 PM
MET WITH:	Administrator Ramona Eleco		TIME COMPLETED:	06:20 PM

ALLEGATION(S):

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Resident overdosed while in care
Staff did not ensure that resident had a sufficient intake of liquids

INVESTIGATION FINDINGS:

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An Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Administrator (Admin) Ramona Eleco & stated purpose of visit.

Continued.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurg	TELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

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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Control Number 24-AS-20211011111843

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: JASMIN TERRACE AT BAKERSFIELD	FACILITY NUMBER: 157208773
	VISIT DATE: 12/20/2021

NARRATIVE

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Continued from Page 1.

The Department reviewed resident records for Resident 1 (R1), interviewed R1, referenced in the complaint, and facility staff. Medication records did not show discrepancies. Toxicology report was unremarkable. R1 & facility staff denied R1 taking illicit drugs or medication not prescribed to R1. According to R1 hospital records there was no indications that R1 overdosed.

R1 is independent & able to get own water when thirsty. Facility staff denied R1 being dehydrated & that water is always available to residents. Large water jug & juice dispenser observed in dining room that residents have access to. R1 stated that they know where the water is & is able to get water on own when thirsty.

The Department has investigated the above complaints & determine them to be Unfounded.

Exit interview conducted with Admin. Report Provided.

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurg	TELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC9099 (FAS) - (06/04)

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