157208773-9-26-2022-24-AS-MHON-CK4PK4-20221011112232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 09/21/2022
Date Signed: 09/26/2022 09:56:38 AM

Substantiated

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
07/13/2022 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20220713124246

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: 83	DATE:	09/21/2022
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Ramona Eleco, Administrator		TIME COMPLETED:	08:00 PM

ALLEGATION(S):

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Facility is not maintained in good repair
Facility alarm makes the residents uncomfortable

INVESTIGATION FINDINGS:

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On 09/21/22, Licensing Program Analysts (LPAs) L. Salazar and V. Gorban arrived at the facility unannounced to deliver findings on the above allegations. LPAs were greeted by Administrator, stated purpose of the visit and were allowed entry into the facility.

During the investigation, LPAs toured the facility and observed 3 out of 6 interior facility doors that lead to the outside courtyard tohave holes in them and are in need of repair. Floor in the entry and common area of the facility are in disrepair. LPAs heard the continuous loud beeping of the call light system, which travels throughout the facility until calls are answered. LPA Salazar conducted interviews with residents that stated the beeping occurs all day long and causes mental distress.

(continued on 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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 3

Control Number 24-AS-20220713124246

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: 09/21/2022

NARRATIVE

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(Continued from 9099)

Based on LPAs audible and visual observations and interviews with residents, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies is being cited on the attached 9099-D.

An exit interview was conducted with Administrator. A copy of this report and appeal rights were provided to Administrator and a plan of correction was developed by Administrator and reviewed with LPA.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 24-AS-20220713124246

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/21/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/21/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	Administrator will replace the 3 broken doors and provide pictures / receipts evidencing the new doors by POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by LPAs observation of holes in interior facility doors that lead to the outside and floor in the entrance of the facility was in disrepair.	8 9 10 11 12 13 14
Type B 10/21/2022 Section Cited CCR 87307(d)(2)	1 2 3 4 5 6 7	Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities:(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.	1 2 3 4 5 6 7	Administrator will submit a plan of action on how to address the loud beeping sounds of the call lights by POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by LPAs interviews with residents and LPAs observation of the auditory alarm system that is continuously beeping loudly throughout the facility. Interviews with residents state this is causing mental distress.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

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