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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 11/15/2023
Date Signed: 11/15/2023 05:56:10 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
07/31/2023 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20230731144332
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: 72DATE:
11/15/2023
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Activities Director Candaleria CarrilloTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff make inappropriate comments towards residents
Staff do not treat residents with dignity
Staff are not able to effectively communicate with resident
Staff are mismanaging resident's medication

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette arrived unannounced to conduct a complaint investigation. LPA identified herself and discussed the purpose of the visit and delivered findings. LPA met with Activities Director Candaleria Carrillo who contacted Administrator Ramona Eleco who gave permission to sign for this report.

LPA obtained R1's file and interviewed staff and residents.

Based on interviews with staff and residents, Staff did not treat residents with dignity, do not communicate effectively with residents and make inappropriate comments towards residents.

Based on record review and interviews, staff are mismanaging residents medications. According to records R2, R3 and R4 missed medications on 07/31/23.
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: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
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
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
07/31/2023 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20230731144332

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: 72DATE:
11/15/2023
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Activities DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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2
3
4
5
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9
Staff did not prevent resident from being inapprorpiately touched
Staff are not safeguarding residents personal items.
Staff are not scheduling residents appointments
Staff refused to provide resident with food
Staff are not meeting resident's showering needs
Residents a/c is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette arrived unannounced to conduct a complaint investigation. LPA identified herself and discussed the purpose of the visit and delivered findings. LPA met with Activities Director Candaleria Carrillo who contacted Administrator Ramona Eleco who gave permission to sign for this report.

LPA obtained R1's file and interviewed staff and residents.

Based on interviews, it is unknown if staff did not prevent a resident from being inappropriately touched.

Based on interviews, it is unknown if staff are not safeguarding residents personal items.

Based on interviews and record review, it is unknown whether or not staff are scheduling residents appointments.
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: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
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 5
Control Number 24-AS-20230731144332
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: 11/15/2023
NARRATIVE
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Based on interviews, it is unknown whether or not staff are refusing to provide residents with food. Per interviews facility provides a serving of the original meal to residents, however for a second serving if facility runs out of the original meal residents are provided a peanut butter and jelly sandwich.

Based on interviews and shower schedule, it is unknown whether or not staff are meeting residents shower needs.

Based on interviews and record review although the AC needed to be repaired facility contacted AC repair company, offered to move residents to a unit with AC or offered residents a fan until the AC unit was fixed.

Based on record review and interviews, it is undetermined whether or not the allegations occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 24-AS-20230731144332
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: 11/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2023
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1)To be accorded dignity in their personal relationships with staff,


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Plan of Correction Licensee agrees to conduct a staff training on personal rights and will submit an agenda with sign in sheet by POC due date.
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residents, and other persons. This requirement was not met as evidenced by: Licensee did not ensure S1 treated R2 and R6 with dignity and respect, which poses an immediate health safety and or personal rights risk to residents in care.
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Type A
12/01/2023
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the
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Plan of Correction Licensee agrees to conduct a medication training and submit agenda and sign in sheet by POC due date 12/1/23.
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following: (4) The licensee shall assist residents with self-administered medications as needed.This requirement was not met as evidenced by: Licensee did not administer medications on 7/31/23 for R2, R3 and R4, which poses an immediate health safety and/or personal rights 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: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20230731144332
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: 11/15/2023
NARRATIVE
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Based on record review and interviews, the preponderance of evidence standard has been met; therefore, the above allegations are 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 Activities Director Candaleria Carillo and a copy of this report along with appeal rights and plan of correction were provided.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5