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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 02/09/2023
Date Signed: 02/09/2023 02:40:24 PM

Substantiated


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
11/03/2022 and conducted by Evaluator Katie Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221103095508
FACILITY NAME:JASMIN TERRACE AT BAKERSFIELDFACILITY NUMBER:
157208773
ADMINISTRATOR:ELECO, RAMONA D.FACILITY TYPE:
740
ADDRESS:5400 STINE ROADTELEPHONE:
(661) 398-8802
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:99CENSUS: 80DATE:
02/09/2023
UNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH: Ramona ElecoTIME COMPLETED:
03:03 PM
ALLEGATION(S):
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Improper use of postural supports
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to conduct a subsequent interview and deliver complaint findings. LPA met with and explained the reason for the visit with Administrator (AD) Ramona Eleco.

During the visit, LPA toured the facility and conducted resident and staff interviews. Resident (R1) was observed sitting in a wheelchair in the dining room waiting for lunch. A padded strap was wrapped around R1 which fastened in the back of the wheelchair. R1 was unable to reach the fastener or release the belt. Additionally, during ths visit, R1 was observed resting in bed with full side rails in raised position.
Based on observation and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D.

An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 24-AS-20221103095508
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2023
Section Cited
CCR
87608(a)(2)
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87608 Postural Supports (a) Based on the individual's.... the facility shall provide assistance and care for the resident in those activities of daily living...postural supports may be used under the following conditions.(2) Postural supports shall be fastened or tied in a manner that permits quick release by the resident.
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AD has agreed to provide R1 with a self releasing lap belt and obtain a revised physician's order. AD will provide proof of the new belt and physician's order to CCLD via pictures and video via email by the due date.
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This requirement was not met as evidenced by:

Licensee did not ensure that R1's postural support lap belt permits quick release by the resident. R1's lap belt fastenes in the back of R1's wheelchair, R1 cannot reach it.

This poses a potential health, safety or personal rights risk to persons in care.
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Type B
02/16/2023
Section Cited
CCR
87608(a)(5)(B)
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87608 Postural Supports (a) …the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include….limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care…….
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AD has agreed to have the full rails removed and half rails placed. AD will obtain a revised physician's order for the half rails. Proof of correction will be provided with pictures to be emailed to CCLD by the due date.
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This requirement was not met as evidenced by:

Licensee did not ensure that full bed rails were only used for residents receiving hospice. R1 has an order for half side rails. R1 was observed in bed will full bedrails in raised position.
This poses a potential health, safety or personal rights risk to persons in care.
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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: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
11/03/2022 and conducted by Evaluator Katie Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221103095508

FACILITY NAME:JASMIN TERRACE AT BAKERSFIELDFACILITY NUMBER:
157208773
ADMINISTRATOR:ELECO, RAMONA D.FACILITY TYPE:
740
ADDRESS:5400 STINE ROADTELEPHONE:
(661) 398-8802
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:99CENSUS: 80DATE:
02/09/2023
UNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH: Ramona ElecoTIME COMPLETED:
03:03 PM
ALLEGATION(S):
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9
Staff are not changing resident’s clothing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to conduct a subsequent interview and deliver complaint findings. LPA met with and explained the reason for the visit with Administrator (AD) Ramona Eleco.

During the visit, LPA toured the facility and conducted resident and staff interviews. R1 was observed in clean clothing. Staff interviews reveal that R1’s clothes are changed throughout the day as needed. There is no documentation of how often resident clothing is changed. The above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

No citation issued
An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5