197607655-10-19-2023-28-AS-TVAO-CX5NB8-20231031101839

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 10/19/2023
Date Signed: 10/19/2023 03:49:54 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
10/16/2023 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231016153749

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: 139	DATE:	10/19/2023
		UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Elizabeth Kirk - Supervisor		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Elizabeth Kirk and explained the reason for the visit.

The investigation consisted of the following: LPA requested staff/resident rosters. Interviewed administrator, staff #1-#3(S1-S3) and residents 1-7(1-7). LPA requested a copy of physician's report, identification and emergency information sheet, admission agreement, and personal property and valuables sheet for R1.

The investigation revealed the following: Regarding allegation: Staff do not safeguard resident's personal belongings. It is alleged many of resident’s personal belongings have gone missing since they were transported to the facility. Interviews conducted with residents revealed, 5 out 8 residents stated that personal belongings have not disappeared from their rooms and when they moved in all their items were provided to them. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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 2

Control Number 28-AS-20231016153749

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: 10/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

2 out of 8 residents stated that items have disappeared and did not know what happened to them. 1 out of 8 residents was unable to answer questions due to cognitive skills. Interviews with staff revealed, 4 out of 5 staff interviewed stated that recently they have been assisting a resident who moved-in on 8/9/23 to bring personal items from the resident’s previous residence to the facility. Per staff resident has stated that personal items have gone missing. However, the items have been found in the room or are still slowly being cleaned and provided to the resident. Assistant administrator explained that the resident requested assistance with brining items from the previous residence to the resident’s room. Upon going to the previous residence and picking up the items staff observed an infestation of bugs in the apartment. Therefore, the staff decided to continue to assist the resident but in order to prevent bringing any bugs into the facility they will clean the items first. Prior bringing the items into the resident’s room, the staff are cleaning, ensuring there are no bugs in the items, washing the clothes first. The resident was made aware about this process and explained the reason why it was being done that way. Although the items may have not been provided to the resident right away. The facility is ensuring to avoid an infestation of bugs inside the resident’s room and the items are being provided to the resident clean. Document reviewed revealed resident had 3 items listed on the personal property and valuables upon arriving at the facility. An update of the personal property and valuables is to be done upon resident has all her items in the room as the transition is still on going since the resident moved in.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Lori Lackey Assistant Administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2