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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 09/25/2026
Date Signed: 09/25/2026 10:29:57 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
09/01/2026 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260901145139
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: DATE:
09/25/2026
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lori Lackey, Assistant Executive DirectorTIME COMPLETED:
10:40 AM
ALLEGATION(S):
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Staff did not safeguard resident’s personal property
Staff did not answer communications from resident’s representative
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 Assistant Executive Director, Lori Lackey and LPA explained the purpose of today's visit.

On 9/3/2026, 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 the Executive Director, Staff #1 (S1) to Staff #9 (S9), Resident #1 (R1) to Resident 8# (R8), and Witness #5 (W5). LPA interviewed Witness #1 (W1) to Witness #4 (W4) over the phone. LPA obtained documents from Resident #1 (R1’s) file such as Face Sheet, Physician’s Report, and Resident Safeguard Property/Valuables form. LPA also obtained Staff Training and Theft and Loss Policy.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2026
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 3
Control Number 28-AS-20260901145139
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: 09/25/2026
NARRATIVE
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During today's visit, the investigation consisted with the following: LPA obtained a copy of the resident roster and staff roster. LPA interviewed Resident #9 (R9) to Resident #11 (11).

The investigation revealed the following: in regard to the allegation, “Staff did not safeguard resident’s personal property.” It is alleged that R1 has missing personal belongings for the past several months, including a cross, 3 silver rings, pair of silver hoop earrings, black watch with silver face and 2 silver chain necklaces. LPA interviewed the Executive Director and S1 denied the allegations stating the facility staff was reported about the missing belongings by R1’s social worker on 9/1/2026. Per Executive Director and S1, the staff conducted searching for the belongings on 9/1/2026 and were able to find a cross, three (3) silver rights, pair of silver hoop earrings, black watch with silver face, and two silver chain necklaces. The Executive Director and S1 both stated that they were able to find all the missing items and informed R1’s representative on 9/3/2026. LPA interviewed R1’s representative that confirmed that R1’s missing belongings were found and notified by S1 on 9/3/2026. R1’s representative also stated not providing the facility a list of R1’s personal belongings. LPA obtained R1’s file that had a Client / Resident Personal Property Valuables LIC621 form that was blank with no personal items listed but was signed by the power of attorney (POA) dated on 06/11/2025. LPA interviewed eight (8) staff stating being informed about R1’s missing belongings from the Executive Director and their supervisors on 9/1/2026 and helped conduct searching and findings R1’s missing belongings. LPA interviewed R1 that stated not missing any of R1’s belongings. LPA interviewed R1’s current roommate that stated not witnessing any staff or resident steal R1’s personal belongings and have not heard from R1 that R1’s personal belongings are missing. Per R1’s roommate also stated not missing any belongings as well. LPA interviewed one (1) resident that stated missing belongings but did not report to staff. LPA interviewed an additional nine (9) residents that denied the allegation stating not missing any of their personal belongings. LPA reviewed the facility’s theft and loss policy that states that it is the responsibility of the facility’s staff, residents, and resident family members to work together to identify any theft/loss problems, and to report information that may lead to the discovery of the person/people responsible for stealing or losing resident’s property. There is not enough evidence to substantiate.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260901145139
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: 09/25/2026
NARRATIVE
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Allegation: ”Staff did not answer communications from resident’s representative.” It is alleged that R1’s representative does not receive any follow-up due to a lack of consistent communication with facility staff. LPA interviewed R1 that stated that the facility does continue to follow up and notifies R1’s representative whenever an incident occurs. LPA interviewed nine (9) out of eleven (11) residents that denied the allegation stating that the facility staff notifies and follows up with their representatives whenever an incident occurs. One (1) out of eleven (11) residents stated being not sure if the staff notifies and follows up with that representatives whenever an incident occurs. LPA interviewed S1 that denied the allegation stating not being contacted by W1 regarding R1’s missing personal belongings. LPA interviewed W1 that corroborated with the allegation stating that W1 spoke with S1 regarding W1’s missing belongings on March 2026 and wasn’t contacted nor followed up. Per Executive Director and S1 stated not ever being contacted by W1 regarding R1’s missing belongings. Executive Director and S1 both stated that they found out about R1’s missing belongings when they were informed by a social worker on 9/1/2026. Per the Executive Director and S1 both confirmed contacting W1 regarding R1’s missing personal belongings on 9/1/2026. W1 confirmed being contacted being contacted on 9/1/2026 regarding R1’s missing personal belongings. W1 also confirmed that S1 contacted W1 on 9/3/2026 that all the missing personal belongings that were reported were found and was provided a photo of R1’s personal belongings that were found. Executive Director stated that the social worker was also informed on 9/3/2026 that R1’s missing belongings were found. LPA interviewed one (1) staff that stated not being involved in contacting resident’s representatives. LPA interviewed five (5) staff that stated that whenever an incident occurs, they immediately contact their supervisors. LPA interviewed two (2) staff supervisors that stated that they would contact the Executive Director, resident’s power of attorney, and physician whenever a health-related incident occurs. LPA interviewed four (4) additional Witnesses that are representatives for other residents that denied the allegation stating that they are notified and followed up with staff regarding incidents that occur to the residents. There is not enough evidence to substantiate.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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 held, and a copy of this report was provided to the Assistant Executive Director, Lori Lackey.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3