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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 01/18/2023
Date Signed: 01/30/2023 01:10:47 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
11/21/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20221121164233
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: 78DATE:
01/18/2023
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Ramona Eleco, AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff are not properly trained
INVESTIGATION FINDINGS:
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On 01/18/2023, Licensing Program Analysts, L. Salazar and M. Garza arrived at the facility unannounced to deliver findings on the above allegation. LPAs were greeted by Administrator, stated the purpose of the visit and were allowed entry into the facility.

During the investigation, LPA conducted interview with Administrator and reviewed the medication training records for all staff that administer medications. (Med-Techs). Based on interview with Administrator and records review conducted, 5 out of 5 staff training records, evidence that staff do not have the required 8 hour annual medication training.

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

(Continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
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)
Page: 1 of 4
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
11/21/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20221121164233

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: 78DATE:
01/18/2023
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Ramona Eleco, AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff made inappropriate comments towards resident
Staff are mismanaging residents medication
Staff engaged in a verbal altercation with resident
INVESTIGATION FINDINGS:
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On 01/18/2023, Licensing Program Analysts, L. Salazar and M. Garza arrived at the facility unannounced to deliver findings on the above allegations. LPAs were greeted by Administrator, stated the purpose of the visit and were allowed entry into the facility.

During the investigation, LPA Salazar conducted record review of Resident (R1's) file and Centrally stored medication records. Based on records review and interviews, LPA found that there was not sufficient evidence to show resident's personal rights were violated by staff or that the facility was mismanaging resident's medications.

Based on interviews conducted and records review, the above allegations are UNSUBSTANTIATED. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies cited during this complaint visit. Exit interview conducted. A copy of this report was given to Administrator, whose signature confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
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)
Page: 2 of 4
Control Number 24-AS-20221121164233
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: 01/18/2023
NARRATIVE
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(Continued from 9099)

An exit interview was conducted, and a plan of correction was reviewed and developed with Administrator with a Plan of correction date of 02/20/2023.

A copy of this report and appeal rights were discussed and provided to Administrator, Ramona Eleco, whose signature on this form confirms receipt of this document.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
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
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20221121164233
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: 01/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/03/2023
Section Cited
HSC
1569.69(b)
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ยง1569.69 Employees assisting residents with self-administration of medication; training requirements.
(b) Each employee who received training...and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication related issues in each succeeding 12-month period.
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Administrator will provide and complete the required annual medication training for all staff assisting in medications by 02/20/2023. Administrator will send proof of training to LPA via email.
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This requirement was not met as evidenced by LPAs interview with Administrator and records review of staff training show last medication training's for current staff were in 2019. If not corrected, this poses a potential risk to residents 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: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
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)
Page: 4 of 4