157208773-4-26-2023-24-AS-SPIY-CSTLQJ-20230615085736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 04/26/2023
Date Signed: 04/26/2023 07:49:39 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
04/19/2023 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20230419161010

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: 80	DATE:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	03:36 PM
MET WITH:	Administrator Ramona Eleco		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Resident is not receiving proper care, resulting in multiple ER visits for UTI

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shawna Doucette arrived unannounced to conduct a 10 day complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Ramona Eleco.

LPA obtained copies of R1's file and interviewed Administrator. LPA reviewed files. After review of files, facility does not have a restricted health care plan for R1's restricted health condition. R1's needs and service plan has not been updated since 09/19/19 and does not include R1's restricted health condition. LPA requested copies of inicdent reports for R1's hospitalizations. Administrator was unable to provide incident reports for R1 for 2/24/23, 03/18/23 and 4/18/23.

LPA requested copies of home health records for R1. Adminsitrator was unable to provide records and requested the records from home health during the visit. Administrator was only able to provide dates home health responded to the facilty for R1 and had no further documentation.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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-20230419161010

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: 04/26/2023

NARRATIVE

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Based on record review and interviews, 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.

An exit interview was conducted with Administrator Ramona Eleco and a copy of this report along with appeal rights and plan of correction were provided.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 24-AS-20230419161010

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: 04/26/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/08/2023 Section Cited CCR 87616(a)(b)(1)(2)	1 2 3 4 5 6 7	87616 Exceptions for Health Conditions (a) As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. (b) Written requests shall include, but are not limited to, the following:	1 2 3 4 5 6 7	Plan of Correction POC Licensee agrees to submit a plan of care for R1's restricted health condition by POC due date.
	8 9 10 11 12 13 14	(1) Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. (2) The licensee's plan for ensuring that the resident's health related needs can be met by the facility. This requirement was not met as evidenced by Licensee did not have or submit a restricted health care plan to licensing for approval for R1's restricted health condition which poses a potential Health, Safety or personal rights risk to the residents in care.	8 9 10 11 12 13 14
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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 Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

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