157208773-9-6-2022-24-AS-SPIY-CLPMYH-20221201090131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 09/06/2022
Date Signed: 09/06/2022 11:58:05 AM

Unfounded

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
08/29/2022 and conducted by Evaluator Katie Brown

COMPLAINT CONTROL NUMBER: 24-AS-20220829110252

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: 82	DATE:	09/06/2022
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Ramona Eleco		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility ice machine is moldy
Staff are not following resident's special diet physicians order

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the initial complaint visit. LPA met with and explained the purpose of the visit and the elements of the allegations with Administrator (AD) Ramona Eleco.

During the visit, LPA conducted interviews and a record review. LPA toured the dining room and observed the facility ice machine. LPA delivered the investigation findings on this day.

The Department investigated the allegation: Facility ice machine is moldy. During the course of the investigation, LPA observed the facility ice machine. The ice machine is clean and free of mold inside and out. LPA observed the cleaning log and AD explained the cleaning procedure and schedule.

See LIC909-C for continuation of this report

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

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-20220829110252

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: 09/06/2022

NARRATIVE

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The Department investigated the allegation: Staff are not following resident's special diet physicians order. During the investigation LPA conducted interviews and a record review of R1’s Admission Agreement, Physician’s Report, Needs & Service Plan, Medication Administration Record (MAR) and a Discharge Summary from previous placement. R1 does have an order for a Special Diet which is being followed. The Physician’s ordered Special Diet does not include Meal Supplement Drinks or dairy restrictions. There was no agreement made between R1 and AD for special items to be provided by the facility.

This Agency has investigated the complaints listed above. We have found that the complaints are UNFOUNDED, therefore we have dismissed the complaints.

No citations were issued during this visit.

An exit interview was conducted, and a copy of this report was left with AD Ramona Eleco whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC9099 (FAS) - (06/04)

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