197607655-7-28-2026-28-AS-DSIS-DYGTUJ-20261002150225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 07/28/2026
Date Signed: 07/28/2026 09:22:04 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
07/17/2026 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260717095726

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: 143	DATE:	07/28/2026
		UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Rocio Gonzalez, Wellness Director		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Staff do not ensure resident receives adequate feeding assistance while in care
Staff do not ensure residents are provided adequate supervision resulting in residents engaging in physical altercations
Licensee does not ensure all staff are able communicate with residents in care
Staff does not ensure resident receives adequate amounts of hydration while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Daniel Konishi conducted an unannounced subsequent complaint visit to investigate the above allegations. LPA met with the Wellness Director, Rocio Gonzalez and LPA explained the purpose of today's visit.

On 7/23/2026, the initial investigation visit was conducted. The investigation consisted of the following:
LPA obtained a copy of the resident roster and staff roster. LPA interviewed Administrator, Staff #1 (S1) to Staff #8 (S8), and Resident #1 (R1) to Resident #15 (R15). LPA obtained documents from Resident #1 (R1’s) file such as face sheet, physician’s report, and other pertinent documents. LPA also obtained Staff Training and pertinent documents. LPA toured the facility with the Executive Director.

During today's visit the investigation revealed the following: in regard to the allegation, “Staff do not ensure resident receives adequate feeding assistance while in care.” It is alleged that R1 has difficulty swallowing and requires all food to be in puree form. [Conitnue in LIC9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

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

Control Number 28-AS-20260717095726

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JASMIN TERRACE AT EL MOLINO	FACILITY NUMBER: 197607655
	VISIT DATE: 07/28/2026

NARRATIVE

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LPA interviewed the Administrator, and eight (8) out of eight (8) staff that denied the allegation stating that they provide puree form for R1 and other residents that require puree form food. LPA reviewed R1’s physician’s report that confirms that R1 is on a puree diet at risk for aspiration but able to feed self. LPA interviewed R1 that denied the allegation stating that R1 receives puree form food from the staff and provided feeding assistance from staff. LPA interviewed two (2) out of fifteen (15) residents that require puree form food and feeding assistance that denied the allegation stating that they receive food in puree form and feeding assistance from the staff. LPA interviewed twelve (12) out of fifteen (15) residents that do not require puree form food but stated that they notice residents provided feeding assistance from the staff. LPA toured the facility kitchen to observe supply of puree form food, sufficient supply of liquids and puree food being prepped. LPA also observed R1 and other residents at the dining hall eating lunch in puree form being assisted by nine (9) staff from 12:00pm to 12:30pm. There is not enough sufficient evidence to substantiate.

Allegation: “Staff do not ensure residents are provided adequate supervision resulting in residents engaging in physical altercations.” It is alleged that R1 is often left unattended, which has led to falls and physical altercations among memory care residents. LPA interviewed the Administrator and eight (8) out of eight (8) staff denied the allegation that stated that the facility provides sufficient staff to supervise R1 and the other residents. The Executive Director and eight (8) out of eight (8) staff also stated that in case of residents involved in a physical altercation, the staff would immediately intervene, stop the altercation, and separate the residents. The Executive Director and eight (8) out of eight (8) staff also stated the in case of residents falling, the staff would stay with the resident, contact the supervisor, and supervisor conducts the body check, and the staff would contact 9-1-1 if there if the facility requires further medical assistance. LPA reviewed a Special Incident Report (SIR) dated 06/23/2026 indicating an incident that occurred on 6/20/2026 that involved R1 and Resident #2 (R2) involved in a physical altercation in which staff intervened. LPA interviewed R1 that denied the allegation stating that there is sufficient staff to supervise R1 and other residents. R1 could not recall getting involved in a physical altercation with R2 or another resident but stated R1 feels safe at that facility. LPA also interviewed R2 that denied the allegation stating that there is sufficient staff to supervise all residents. R2 could also not recall getting involved in a physical altercation with R1 or another resident but stated R2 feels safe at that facility. LPA interviewed one (1) resident that also denied the allegation which stated not witnessing a physical altercation between residents but witnessing a resident falling and the staff immediately helped that resident. [Continue to LIC9099-C]

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20260717095726

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JASMIN TERRACE AT EL MOLINO	FACILITY NUMBER: 197607655
	VISIT DATE: 07/28/2026

NARRATIVE

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That one (1) resident also stated if there's a physical altercation between residents, staff would immediately intervene, stop the altercation, and separate the residents.. LPA interviewed an additional thirteen (13) residents that also denied the allegation stating that there are sufficient staff to supervise the residents and have not seen physical altercations between residents. However, all thirteen (13) additional residents stated that the staff would immediately intervene, stop the physical altercation, and separate the residents. These thirteen (13) residents also stated that staff would immediately assist the residents if they fall. LPA also obtained staff in-service training dated 8/4/2025 covering Resident Rights and De-Escalation techniques. LPA also obtained staff in-service training dated 04/25/2026 covering Fall Precautions. There is not enough sufficient evidence to substantiate.

Allegation: “Licensee does not ensure all staff are able communicate with residents in care.” It is alleged that some staff in memory care cannot communicate with the residents at the facility because they do not speak or understand English. LPA interviewed the Administrator and eight (8) out of four (8) staff that denied the allegation stating that the on-duty staff are able to communicate with the residents and there is no language barrier. LPA interviewed one (1) out of fifteen (15) residents that did not provide a response to this allegation. LPA interviewed an additional thirteen (13) out of fifteen (15) that denied the allegation stating that the staff are able to communicate effectively with the residents and there is no language barrier. LPA interviewed one (1) out the fifteen (15) residents that denied the allegation but stated that there are times when staff can be difficult to understand since there are staff that primarily speak Spanish. However, that one (1) resident also stated that those staff are doing their best and are able to communicate effectively with the residents. There’s enough sufficient evidence to substantiate.

Allegation: ”Staff does not ensure resident receives adequate amounts of hydration while in care.” It is alleged that R1 is not receiving adequate hydration. LPA interviewed the Administrator and eight (8) out of eight (8) staff that denied the allegation stating that the staff provide adequate hydration serving drinks, water, and beverages during every meal, snack time, med passes, an activity, or provide residents a pitcher of water in their bedrooms. LPA toured the facility observing the facility has sufficient water, drinks, and beverages available for the residents in the dining hall, kitchen, and during activities. LPA observed a pitcher of water in three (3) resident bedrooms. LPA also observed the water station at the front lobby. LPA interviewed R1 that denied the allegation stating that the staff provide adequate hydration by R1 receiving drinks frequently from staff. [Continue to LIC9099-C]

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20260717095726

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JASMIN TERRACE AT EL MOLINO	FACILITY NUMBER: 197607655
	VISIT DATE: 07/28/2026

NARRATIVE

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LPA interviewed an additional fourteen (14) residents that denied the allegation stating that they are provided adequate hydration by staff receiving drinks frequently from staff and are provided a pitcher of water. There is not enough sufficient evidence to substantiate.

Based on statements and interviews conducted with staff, resident, and review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was held and a copy of this report was provided to the Wellness Director, Rocio Gonzalez.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

LIC9099 (FAS) - (06/04)

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