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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 08/03/2021
Date Signed: 08/04/2021 04:38:59 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/14/2021 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210614111301
FACILITY NAME:JASMIN TERRACE AT EL MOLINOFACILITY NUMBER:
197607655
ADMINISTRATOR:VIRGINIA GARCIAFACILITY TYPE:
740
ADDRESS:245 S. EL MOLINO AVE.TELEPHONE:
(626) 578-0460
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY:206CENSUS: 112DATE:
08/03/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Virginia GarciaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility staff caused bruising to resident
Facility staff hit resident
Facility staff handled resident in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Assistant Administrator Lori Lackey and explained the reason for the visit.
The purpose of the visit is to deliver the findings for the above allegations.
Shortly thereafter Administrator Virginia Garcia arrived.
Initial visit was conducted on 6/15/21 and a Health and Safety Check was conducted.
Subsequent visits were conducted on 6/30/21 and 7/15/21 in which staff and residents were interviewed.
In regards to the allegation Facility staff caused bruising to resident, based on interviews conducted and information gathered it was revealed by Pasadena Police Department Representative that there were no bruises on the face and torso of Resident 1. It was alleged that Resident 1 had been punched in the face and torso. Representative also stated that roommate of Resident 1 had not witnessed anything physically harmful being done to Resident 1. Stated he asked Resident 1 for a timeline and she stated a couple weeks ago, then a couple months ago. Police investigation was Unsubstantiated.
Staff interviewed stated that there have never been complaints against Staff 1 and also that no bruising had been observed to the face or torso.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn TruemanTELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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 2
Control Number 28-AS-20210614111301
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: JASMIN TERRACE AT EL MOLINO
FACILITY NUMBER: 197607655
VISIT DATE: 08/03/2021
NARRATIVE
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Interviews with residents revealed that staff will check on residents every 2 hours and staff are professional.
Roomate of Resident 1 stated she has not seen anyone harm Resident 1 physically.
Stated she has not seen anyone mistreated and hasn't heard of anyone mistreated.
Interview with Resident 1 who stated that staff 1 always punches in the face and had a black eye.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED

In regards to the allegation Facility staff hit resident, based on interviews conducted and information gathered Pasadena Police Department Representative stated that there were no bruises on the face and torso of Resident 1. It was alleged that resident 1 had been punched in the face and torso.
Also police representative stated that roommate of Resident 1 had not observed any wrong doing by Staff 1.
Stated he asked Resident 1 for a timeline and she stated a couple weeks ago, then a couple months ago.
Police investigation was Unsubstantiated.
Roommate of Resident 1 had not witnessed anything physically harmful being done to Resident 1 and did not see any punches by staff against resident 1.
Residents interviewed stated that staff does a good job. 1 resident who knew Staff 1 said Staff 1 does a good job and is never out of line.
Staff interviewed had not observed any bruises to the face or torso of Resident 1.
Interview with Resident 1 who stated that Staff 1 always punches in the face and had a black eye.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED

In regards to the allegation Facility staff handled resident in a rough manner, based on interviews conducted and information gathered police representative stated that roommate of Resident 1 had not observed any wrong doing by Staff 1. There is no evidence to support rough play occurring.
Stated he asked Resident 1 for a timeline and she stated a couple weeks ago, then a couple months ago
Police investigation was Unsubstantiated.
Residents interviewed stated that staff does a good job. 1 resident who knew Staff 1 said Staff 1 does a good job and is never out of line. Residents also stated that staff do a good job with diaper changes and have not been treated rough.
Staff interviewed stated that they check on residents every 2 hours and are not rough.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED





SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn TruemanTELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2