197607655-1-17-2023-28-AS-RORN-CPK2JM-20230302162634

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 01/17/2023
Date Signed: 01/17/2023 12:46:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
01/12/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230112164253

FACILITY NAME:	JASMIN TERRACE AT EL MOLINO		FACILITY NUMBER:	197607655
ADMINISTRATOR:	VIRGINIA GARCIA		FACILITY TYPE:	740
ADDRESS:	245 S. EL MOLINO AVE.		TELEPHONE:	(626) 578-0460
CITY:	PASADENA	STATE: CA	ZIP CODE:	91101
CAPACITY:	206	CENSUS: 126	DATE:	01/17/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Virginia Garcia		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility is in disrepair
Facility is unkempt

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Christine Wong conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Denise Miller (Office Coordinator) and explained the reason for the visit. Shortly after the assistant administrator Lori Lakcey and administrator Virginia Garcia arrived and assisted with the visit.

The investigation consisted of the following: On today's date, LPA interviewed 11 residents and 6 staff and administrator, obtained staff resident and staff roster and toured the facility (1st Floor).

The investigation revealed of the following: In regard to the allegation of "Facility is in disrepair" LPA interviewed 11 residents and 10 out of 11 residents reported the facility is in good condition and good repair. The residents reported they did realize there's flooding in the facility a week ago but does not affect them at all. It's only part of the area on the first floor.

(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230112164253

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JASMIN TERRACE AT EL MOLINO	FACILITY NUMBER: 197607655
	VISIT DATE: 01/17/2023

NARRATIVE

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LPA also interviewed staff and reported facility is a good repair and no residents even complaint about the facility was in disrepair. Administrator reported they did have the flooding issue about a week ago but everything is dry up already. It only flooded part of the area on the first floor which included two residents room (Room#101 and #103), family room and hallway near the dining area. When the flooded came, they immediately removed those two residents' rooms to another room and administrator immediately called staff to come into the facility and helped out and pushed the water out and dry the facility by using the suction machine. After two to three hours, all water was pushed out and there were no more flooding. The plumbing company also came and assessed the problems which was the pipe issues and may have to replace it all. LPA also toured the two residents' rooms, hallway and family room and currently everything is in good condition.

In regard to the allegation of "Facility is unkempt" LPA interviewed 11 residents and 10 out of 11 residents reported the facility is well kept. They have no issues with their rooms and everything is working probably in their rooms. LPA also interviewed staff and all denied the allegation. LPA also toured the facility and LPA did not observe any flooding or water traveling from shower to the toilet in residents' rooms. LPA also did not observe any hole in the ceiling in the dining room. Administrator also reported no resident ever complaint about the facility is unkempt and also they are in the process of doing different renovations in the facility which to maintain the facility to be up-to-dated.

Based on the interviews conducted with residents and staff and LPA's observation, 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 allegations are UNSUBSTANTIATED.

Exit interview was conducted with Virginia Garcia Administrator and a copy of this report and appeal right was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

LIC9099 (FAS) - (06/04)

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