197607655-1-20-2023-28-AS-RORN-CQ5M6X-20230321092036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 01/20/2023
Date Signed: 01/20/2023 01:10:37 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
01/13/2023 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230113110129

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: 127	DATE:	01/20/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Virginia Garcia		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility staff did not provide resident(s) meal(s) in a timely manner.
Facility staff gave resident unsanitary/dirty fruit.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Virginia Garcia and Assistant Administrator Lori Lackey and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Virginia Garcia, Assistant Administrator Lori Lackey, Staff 1-4, and Residents 1-11 (R1-11). LPA obtained copies of Staff and Resident Rosters and facility menu including Menu Substitutions and Menu for Soups of the Day. LPA conducted a tour of enitre facility inside and out. The tour included observations of faciility kitchen, food supply and dining area(s).

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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-20230113110129

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: 01/20/2023

NARRATIVE

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Investigation revealed the following: Regarding allegation, Facility staff did not provide resident(s) meal(s) in a timely manner, it is alleged that facility residents wait long periods of time for their meals. Interviews conducted with 6 out of 6 staff revealed that the facility residents are served all their meals on time. Staff stated that the facility is still providing tray service to some residents due to the COVID19 pandemic and that some residents eat in the dining room. They stated that all meals are always served and/ or delivered in a timely manner. Staff stated that residents also do not wait long when they request an alternate food item if they happen to not like what is on the menu that day. Interviews conducted with 11 out of 11 residents revealed that they are served all their meals timely and they never wait long periods of time for their food to be served and/ or delivered. 11 out of 11 residents stated they are satisfied with the food service and do not have any concerns regarding the food service or anything else. They also stated that if they request an alternate food item they do not wait a long time. During the time of the visit, LPA observed residents being served breakfast and also lunch. LPA observed the meals to be served timely and being prepared to be served in a timely manner. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegation, Facility staff gave resident unsanitary/dirty fruit, it is alleged that residents are served food that does not look fresh and it is also alleged that a staff member picked up fruit from the floor and returned it to a bowl and gave back to a resident to eat. Interviews conducted with 6 out of 6 staff revealed that the facility residents are always served fresh, sanitary and clean food. Staff deny that residents are ever given anything food item that has fallen on the floor back to them to eat. Staff stated that when residents drop food they are given another serving. Staff also stated that if residents drop any silverware it is also replaced with a clean one. Staff stated that all food is always served fresh including meals that are alternates/ substitutions which are served when a resident requests it due to them not wanting to eat what is on the menu. Staff also stated that meals that are delivered via tray service are covered for delivery and uncovered when it is delivered to the residents. Interviews conducted with 11 out of 11 residents revealed that they are satisfied with the food service and do not have any complaints about it. 11 out of 11 residents stated that the food is served fresh, their fruit is fresh and clean. They stated that they are never served food that does not look fresh and are never served food that fell to the floor. 11 out of 11 residents stated that they do not have any concerns regarding the food or anything else. During the time of the visit, LPA toured the facility kitchen and inspected the food supply. LPA observed the fruit and vegetables and other fresh food items to look fresh and all food that staff was in the process of preparing for lunch delivery was covered with plastic wrap. LPA

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230113110129

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: 01/20/2023

NARRATIVE

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also observed an ample amount of food. There was enough food for 7 days non-perishables and 2 day perishables. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegation.

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.

Exit interview held. A copy of the report was provided to Administrator Virginia Garcia.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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