197607655-10-31-2023-28-AS-TVAO-CY8RAE-20231205115100

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 10/31/2023
Date Signed: 10/31/2023 02:46:49 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
10/24/2023 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231024124234

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: 129	DATE:	10/31/2023
		UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Malou Bernardo - Business Office Manager		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff attempted to financially abuse resident while in care.

INVESTIGATION FINDINGS:

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

The investigation consisted of the following: LPA requested a copy of staff/resident rosters. Interviewed administrator, staff #2-#5(S2-S5), and resident #1-7(R1-R7). Reviewed R1’s file and requested copies of physician’s report, face sheet, admission agreement, assisted living waiver(ALW) individual service plan agreement, resident’s facility invoices. LPA attempted to interview ALW’s social worker and R1’s family members.

The investigation revealed the following: Regarding allegation: Staff attempted to financially abuse resident while in care. It is alleged resident was brought inside the branch in a wheelchair by two facility’s employees and stated were “here to help assist resident with getting a debit card and a cashier's check”.
(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: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

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-20231024124234

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: 10/31/2023

NARRATIVE

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Interview with Administrator and Assistant administrator revealed R1 was recently admitted to the facility and have attempted to obtain the family’s assistance but have not been able to. Facility is assisting R1 with arranging finances as currently R1 is self-responsible for own finances and recently obtained financial information from social security. Assistant administrator, driver, and R1 visited R1’s banks to assist R1 with access to accounts. Although assistant administrator spoke with bank staff, R1 provided the information for the account. Per documents reviewed R1 was admitted to the facility on 5/9/23. Physician’s Report dated 5/3/23 notes R1 has dementia and cannot handle own cash resources. However, ALW’s individual service plan notes R1 is legally self responsible. Interviews conducted with additional residents revealed the facility’s staff does not become involved in their financial decisions. Residents are taken to make purchases which they pay for on their own. Interviews conducted with staff revealed facility’s driver assist residents with going to appointments, stores to shop, bank, etc. Driver uses facility’s fund trust credit card to make purchases for residents when the residents request something and they cannot go. Although the facility did take R1 to the bank and communicated R1’s needs, the staff was not attempting to financially abuse R1. However, staff attempted to assist R1 with access to R1’s accounts in order for R1 to be able to finance R1’s current needs. The facility is currently assisting R1 with the process of guardianship or having a responsible party due to R1’s change in condition.
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 Virginia Garcia 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: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC9099 (FAS) - (06/04)

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