<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 08/22/2023
Date Signed: 08/22/2023 01:22:16 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
08/08/2023 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20230808083126
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: 75DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Administrator Ramona ElecoTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not respond to residents call for help
Staff are not properly cleaning ice machine
Facility juice machine is in disrepair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) S. Doucette and LPM S. Moua conducted a joint inspection. The above complaint allegations were discussed and reviewed with Administrator Ramona (Mona).

The Department toured the facility and checked the ice and juice machines. The juice and ice machines were observed with mold and required cleaning. During an inspection, LPAs observed a resident left outside calling for help. Resident is non-ambulatory and was in a wheelchair. The above allegations are Substantiated.


Deficiencies are cited on the attached 9099-D. Appeal rights were provided. Exit Interview was conducted.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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 3
Control Number 24-AS-20230808083126
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: 08/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/01/2023
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7

87303(a) Maintenance and Operation - The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Based on observation, LPA and LPM observed the ice and juice machines with
1
2
3
4
5
6
7

Plan of Correction POC Licensee agrees to clean the ice and juice machine by POC due date 09/1/23.
8
9
10
11
12
13
14
mold, which poses a potential health and safety concerns to the residents in care.
8
9
10
11
12
13
14
Type B
09/01/2023
Section Cited
CCR
87468.1(a)(1)
1
2
3
4
5
6
7

87468.1(a)(1) Personal Rights of Residents in All Facilities- Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff,

1
2
3
4
5
6
7
Plan of Correction POC Licensee agrees to conduct training on personal rights by POC due date 09/01/23
8
9
10
11
12
13
14
residents, and other persons. This requirement was not met as evidenced by: Based on observation, LPAs observed R1 left outside calling for help, which poses a potential health and safety concern.

8
9
10
11
12
13
14
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: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
08/08/2023 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20230808083126

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: 75DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Administrator Ramona ElecoTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent resident from engaging in inappropriate behaviors
Staff are not providing adequate food service to residents
Staff are not rotating bedbound residents
Staff are not properly storing medication
Staff are not awake during the night
Staff left residents in soiled clothing
Resident’s rooms are malodorous

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) S. Doucette and LPM S. Moua conducted a joint inspection. The above complaint allegations were discussed and reviewed with Administrator Ramona (Mona).

The Department conducted interviews, reviewed records, toured the facility, and checked medications and the food supply. During the tour, LPA and LPM observed lunch being served. The food supply and lunch were warm and sufficient in quantity. No inappropriate behaviors were observed. There were no odors and residents were not observed in soiled clothing. Records reviewed indicated that bedbound resident referenced in the complaint was turned, under hospice care, and hospice noted no concerns. Medications are kept in the locked med room and facility has 3 NOC staff working during the night. The above allegations are Unsubstantiated.

Exit interview was conducted.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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 3