157208773-1-22-2021-24-AS-KHOS-BZ6JDN-20210316065750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 01/22/2021
Date Signed: 01/22/2021 05:05:32 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
01/08/2021 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20210108160459

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:	DATE:	01/22/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Ramona Eleco		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained unexplained bruising while in care.
Facility staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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Consistent with federal guidelines and Executive Order issued by Governor Gavin Newsom to improve infection control and prevent the transmission of COVID-19 to our most vulnerable and high-risk residents, the Department conducted this inspection by phone.

On this date Licensing Program Analyst (LPA) K. Mcclurg conducted a Complaint tele-visit with Administrator (Admin)Ramona Eleco and another tele-visit with possible Resident 1's (R1's) Power of Attorney (POA). LPA discussed allegations during independent tele-visits with Admin & POA.

According to Admin & POA, R1 had occasional fall that resulted in the some bruising. According to Admin once dentures were determined to be lost, facility made every effort to locate dentures, including notifying POA. According to POA it was decided not to replace dentures as R1 had been put on hospice with mechanical soft/pureed diet & no longer had need for dentures. According to POA they did not have any concerns regarding R1's care received at facility.

The Department has investigated the allegations & have determined that they are unfounded.

Exit interview conducted with Admin. Report Provided.

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: 01/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2021

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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