157208773-11-23-2022-24-AS-SPIY-CLLLVB-20221128080512

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 11/18/2022
Date Signed: 11/23/2022 01:55:41 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
10/18/2022 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20221018105202

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:	11/18/2022
		UNANNOUNCED	TIME BEGAN:	07:34 AM
MET WITH:	Administrator, Ramona Eloco		TIME COMPLETED:	08:43 AM

ALLEGATION(S):

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Staff did not asssit resident with toileting needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced follow up visit. LPA Williams met with staff, discussed the purpose of the visit, and conducted a tour of the facility by himself. The Administrator, Ramona Eloco arrived at a later time.

LPA Williams observed residents eating breakfast in the dining room and a total of four staff conducting various tasks in the hallways.

LPA Williams met Resident 1 (R1) in their bedroom. R1 reported it has taken staff up to 30 minutes to respond for assistance. LPA Williams sat in the bathroom and pulled the chord,(notifies staff assistance is required) and started a timer on LPA Williams watch at approximately 7:45 a.m. According to LPA Williams watch, it took approximately 7 minutes for a staff to respond and assist R1.

*Continued on LIC 9099C*

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

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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Control Number 24-AS-20221018105202

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: 11/18/2022

NARRATIVE

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According to interviews conducted on 10/20/2022, three residents reported they have no concerns regarding staff responding to their pull chord.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC9099 (FAS) - (06/04)

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