157208773-9-23-2022-24-AS-SPIY-CLPMYG-20221201090131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 09/21/2022
Date Signed: 09/23/2022 09:47:49 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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 Vadim Gorban

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: 83	DATE:	09/21/2022
		UNANNOUNCED	TIME BEGAN:	01:26 PM
MET WITH:	Administrator, Ramona Eleco		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility is unsanitary.

INVESTIGATION FINDINGS:

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This allegation was incorrectly documented on this complaint, it belongs to complaint number 24-AS-20220714131348.

On 09/21/2022 Licensing Program Analysts (LPAs) V Gorban and L Salazar arrived unanounced to the facility stated above. LPAs greeted and were allowed entry into facility. Covid protocol was observed.

During the investigation LPAs toured the facility and observed what appeared to be bodily fluids on the walls of all three hallways. LPAs observed multiple fly traps hanging from the ceiling, above the dining tables where residents were eating, light fixtures in the halls were observed to have cobwebs and bugs, Hallway doors leading to the outside courtyard were observed to be stained with dirt.

Based on LPAs observations, the preponderance of evidence standard has been met, therefore, the allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is cited on the attached 9099D. If not corrected, this poses an potential risk to residents in care.

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

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
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)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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 Vadim Gorban

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: 83	DATE:	09/21/2022
		UNANNOUNCED	TIME BEGAN:	01:26 PM
MET WITH:	Administrator, Ramona Eleco		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
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5
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7
8
9

Staff do not provide appropriate supervision to residents in care

INVESTIGATION FINDINGS:

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11
12
13

This allegation was incorrectly documented on this complaint, it belongs to complaint number 24-AS-2020714131348.
On 09/21/2022 Licensing Program Analysts (LPAs) V Gorban and L Salazar arrived to the facility unannounced to deliver findings on the above allegation. LPAs were greeted by Ramona D Eleco, stated the purpose of the visit and were allowed entry into facility. Covid precautionary measures were/were taken at the time of entry.

During the investigation, LPA reviewed records for Resident R1. Records include Physician's Report (LIC 602) which does not indicate R1 needed one on one supervision at all times. LPA interviewed staff and Administrator.

Although the allegation may have happened, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator. A copy of this report was provided to Administrator. No deficiencies cited.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
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: 2 of 3

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
SIERRA CASCADE AC/SC, 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 10/05/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation 87303(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 clean walls, light fixtures and doors. Administrator will paint hallways and doors to remove stains and submit proof of correction by way of pictures by POC date.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by LPAs observation of facility doors stained with dirt, fly traps hanging over dining room tables and light fixtures surrounded with cobwebs and bugs.	8 9 10 11 12 13 14
Type B 10/05/2022 Section Cited CCR 87470(a)(2)(B)	1 2 3 4 5 6 7	Infection Control Requirements 87470 (a) A licensee shall ensure that infection control practices are maintained as follows:(2)Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows:(B) Walls and window coverings... shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary or when they are visibly contaminated or soiled. Walls and window coverings in resident care areas shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary or when they are visibly contaminated or soiled.	1 2 3 4 5 6 7	Administrator will complete cleaning facility hallway and ceiling lights from cobwebs and bugs. Once done Administrator will notify CCLD when job is completed by 10/05/2022
	8 9 10 11 12 13 14	This requirement is not met as evidenced by LPAs observation of facility hallway walls that were stained with feces and bodily fluids.	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: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
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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