157208773-5-26-2022-24-AS-SMOA-CGWKH7-20220802075437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 05/26/2022
Date Signed: 05/26/2022 09:29:40 PM

Unsubstantiated

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
05/18/2022 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20220518121130

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: 77	DATE:	05/26/2022
		UNANNOUNCED	TIME BEGAN:	07:45 PM
MET WITH:	Administrator (Admin) Ramona Eleco		TIME COMPLETED:	09:45 PM

ALLEGATION(S):

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5
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9

Staff did not provide adequate supervision to resident resulting in inappropriate behavior.

INVESTIGATION FINDINGS:

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13

A Complaint visit was conducted on the date & during the times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Administrator (Admin) Ramona "Mona" Eleco.

According to Admin & facility records, Resident 1(R1) sustained fall in facility courtyard when trying to get to dining room per R1 as told to S1 R1 assessed for injuries in accordance with facility policies & procedures. No other residents observed near R1. R1 did not complain of being pursued by another person. The Department has investigated the above allegation & found it to be unsubstantiated.

Exit interview conduced with Admin. Report provided.

Unsubstantiated

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: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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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