157208773-8-22-2024-24-AS-SPIY-D8ZRZL-20240911132806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208773
Report Date: 08/22/2024
Date Signed: 08/22/2024 03:13:31 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
06/03/2024 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20240603090548

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:	08/22/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Ramona Eleco		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff are not providing residents with adequate towels

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Shawna Doucette arrived at the facility unannounced to commence a complaint investigation and deliver findings. LPA identified herself and explained the purpose of the visit with Administrator Ramona Eleco.

LPA toured the facility. LPA chedked the linen closet where clean towels are stored. LPA located a towel with a large hole in it. LPA took photos.

Based on observation, Staff are not providing residents with adequate towels. Based on observation, 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.

A copy of this report was provided with appeal rights and plans of correction.

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: 08/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

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
06/03/2024 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20240603090548

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:	08/22/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Ramona Eleco		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff are not providing resident with a comfortable environment
Staff are not maintaining the yard
Staff are not assisting residents
Staff did not prevent resident from engaging in inappropriate behaviors
Staff did not safeguard residents personal belongings
Staff are not properly cleaning up residents rooms
Staff left residents in soiled diapers for extended periods of time
Staff are administering medication to resident without disclosing the name of it
Staff are not providing adequate food service for residents

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Shawna Doucette arrived at the facility unannounced to commence a complaint investigation and deliver findings. LPA identified herself and explained the purpose of the visit with Administrator Ramona Eleco.

LPA toured the facility. LPA observed the temperature set at 72 F. LPA observeved the rooms to be clean.
Based on observation, facility was set at a comfortable temperature. Based on interviews, Staff speak to each other in their own language for clear directions for care however staff speak to residents in English.
Based on observation, Staff are maintaining the yard at the facility.
Based on interviews and record review of inconitnent and shower logs, Staff are assisting residents.
Based on interview, staff may or may not have prevented resident from engaging in inappropriate behaviors.
Based on interviews, staff are safeguarding residents personal belongings.
Based on interviews and observations staff are cleaning up residents rooms. LPA checked rooms 39, 17, 36, 30, and 8 which were clean.

Unsubstantiated

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: 08/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

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-20240603090548

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: 08/22/2024

NARRATIVE

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Based on interviews and records review, incontinence log shows residents are being checked every two hours.
Based on interviews, staff are disclosing the name of medications given to residents.

Based on observation and interviews, staff are providing adequate food. LPA observed orange juice, pineapple juice, cranberry juice and apple juice. LPA checked the menu and took photos. Residents had French toast with syrup, pineapple juice, breakfast meat and cornflakes. LPA observed residents have oven fried chicken, pilaf, spinach and a roll for lunch.

Based on interviews, observation and records review, 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.

A copy of this report was provided to Administrator.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 24-AS-20240603090548

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: 08/22/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/30/2024 Section Cited CCR 87307(3)(C)	1 2 3 4 5 6 7	(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:	1 2 3 4 5 6 7	Plan of Correction Licensee agrees to remove and replace all towels/linens with holes. Licensee agrees to conduct a staff training on appropriate linen supplies by POC due date 08/30/24.
	8 9 10 11 12 13 14	(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. This requirement was not met as evidenced by: Licensee had towels with large holes in the linen closet which poses a potential health safety and or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 08/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

LIC9099 (FAS) - (06/04)

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