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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 03/29/2021
Date Signed: 03/29/2021 12:51:47 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
09/04/2020 and conducted by Evaluator See Moua
COMPLAINT CONTROL NUMBER: 24-AS-20200904164752
FACILITY NAME:JASMIN TERRACE AT BAKERSFIELDFACILITY NUMBER:
157208773
ADMINISTRATOR:KIRK, ELIZABETHFACILITY TYPE:
740
ADDRESS:5400 STINE ROADTELEPHONE:
(661) 398-8802
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:99CENSUS: 66DATE:
03/29/2021
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Interim Administrator Ramona "Mona" DeposaTIME COMPLETED:
08:58 AM
ALLEGATION(S):
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9
Staff are harrassing residents
INVESTIGATION FINDINGS:
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2
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5
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9
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12
13
Licensing Program Analyst (LPA) S. Moua called and spoke with Interim Administrator Mona regarding the complaint allegations. Findings were delivered over the phone due to COVID 19 precautionary measures.

The Department conducted interviews with residents and staff. Residents interviewed and staff denied that staff are harassing residents. Resident referenced in the complaint is no longer at the facility. Based on interviews conducted and observation, there is not a preponderance of evidence to prove the alleged violation did occur, therefore, the allegation is Unsubstantiated. No deficiency was observed. Exit interview was conducted.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: See MouaTELEPHONE: (559) 650-7904
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
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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