157208773-1-18-2023-24-AS-SMOA-CNGW5K-20230127155913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 01/18/2023
Date Signed: 01/18/2023 02:17:45 PM

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
01/17/2023 and conducted by Evaluator Mary Garza

COMPLAINT CONTROL NUMBER: 24-AS-20230117132733

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:	01/18/2023
		UNANNOUNCED	TIME BEGAN:	01:44 PM
MET WITH:	Administrator, Ramona Eleco		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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On 1/18/2023 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived at facility to completed an unannounced initial complaint visit. LPAs introduced selvesand were permitted entry into facility. LPAs were not COVID pre-screened upon entry. LPAs met with Administrator, Ramona Eleco and discussed reason for visit. LPAs completed a health and safety check on residents in care. Residents observed in common areas and in rooms.

During visit LPAs completed interviews with staff and residents. LPAs requested a staff and resident roster with contact information. Rooms toured were observed to be in need of repair. Rooms 29, 43 and 48 are not functioning and or not funtioning properly. The allegation listed above is found to have occurred and the preponderance of evidence has been met per Title 22. The allegation is SUBSTANTIATED. Deficiencies cited on LIC 9099D. Exit interview completed with Administrator, Ramona Eleco. A copy of this report and appeal rights have given.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary Garza	TELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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-20230117132733

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: 01/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/27/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 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	Maintence to fix any and all showers not functioning and/or not functioning properly. Administrator to provide in-service for all staff. Administrator to provide a copy of training material and sign in sheet for training provided and a maintence log for corrections made. Administrator to submit to CCL by POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidence by LPA's observations in being that 3 of 6 rooms observed with shower not funtioning or not functioning properly. This is a potential personal rights, health or safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: See Moua	TELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary Garza	TELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

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