157208773-6-29-2023-24-AS-SDOE-CT9NUV-20230629104658

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157208773
Report Date: 06/28/2023
Date Signed: 06/29/2023 10:47:03 AM

Document Has Been Signed on 06/29/2023 10:47 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator Ramona Eleco		TIME COMPLETED:	06:00 PM

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Licensing Program Analysts (LPA)'s Shawna Doucette and Brianna Miranda arrived at the facility unannounced to conduct the Required Annual Inspection. LPA's met with Administrator Ramona Eleco. LPA's disclosed the purpose of the inspection and was granted entry into the facility by the Administrator.

A tour of the facility was conducted with the Administrator. The residence was set at 74 F temperature and free of passageway obstructions inside and outside.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked Medication room. Cleaning supplies were in a locked closet. Smoke detectors and carbon monoxide detectors were checked and operating. Smoke detectors are hard wired with a fire panel and pull station fire alarm. Facility has a fire sprinkler system. Fire extinguishers were charged and had service dates of 05/06/23.

There was outdoor seating for the residents.

Resident, medication and staff records were reviewed. Current first aid and CPR were reviewed..

See LIC809C for continuance.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/28/2023

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Due to time constraints deficiencies are listed below and citations will be issued at a later date. LPAs will return to the facility at a later date or an appointment at the Regional Office will be scheduled. Licensee/Administrator.

LPAs observed the following deficiencies:

Medication errors, medication storage, medication logs, no staff training in all areas, inadequate staffing, no plan of operation, no dementia plan in plan of operation, trash cans without lids, strong urine odor, no restricted health care plans, staff administering injections, no skid mats in shower, shared bathroom needs cleaning, pests were observed in resident bathroom and pest droppings were observed in kitchen, hot water over 125 F and under 85 F, resident records are not current/missing signatures/conflicting information, resident records are accessible in unlocked cabinet in common area, no updated physicians reports, reappraisals, needs and service plans ect., R2 has full bed rails without a doctor note, observed activities schedule but not activities were observed that were on the schedule for 06/28/23..

An exit interview was conducted with Administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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