197607655-3-11-2025-28-AS-TVAO-DEQSC6-20250313134459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 03/11/2025
Date Signed: 03/11/2025 05:00:29 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
02/20/2025 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250220121232

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: 144	DATE:	03/11/2025
		UNANNOUNCED	TIME BEGAN:	04:45 PM
MET WITH:	Virginia Garcia - Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff do not safeguard resident's personal belongings
Staff do not provide resident with a comfortable environment
Staff do not answer resident's call button in a timely manner

INVESTIGATION FINDINGS:

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*This report supersedes report dated 2/24/25 to change report from confidential to public.*
Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Rocio Gonzalez and explained the reason for the visit.

The investigation consisted of the following: LPA requested a copy of staff/resident rosters. Conducted a tour of the facility and observed 10 random resident bedrooms. LPA interviewed 10 residents and 8 staff and requested a copy of resident #1(R1)’s resident personal property and valuables, admission agreement, emergency information sheet, and physician’s report, receipt and letter signed by R1.

The investigation revealed the following: Regarding allegation: Staff do not safeguard resident’s personal belongings. It is alleged resident’s personal belongings were stolen. Interviews conducted with residents revealed 4 out of 10 residents stated to not have lost or have had anything stolen from their rooms. 4 out of 10 residents were unable to answer due to cognitive skills and 2 out of 10 residents stated to have lost personal items at the facility. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

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-20250220121232

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: 03/11/2025

NARRATIVE

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Interviews with staff revealed residents have not complaint of loosing any personal items recently. During the facility’s tour LPA observed one of the three items allegedly stolen in the resident’s bedroom. Per documents the stolen and not observed items were not listed on the resident's personal and property and valuables. Per physician's report R1 is responsible for own cash resources. Assistant administrator last updated personal item list on 8/20/24. Per admission agreement facility is not responsible for items lost unless the personal inventory form was updated.

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.

Regarding allegation: Staff do not provide resident with a comfortable environment. It is alleged resident screams and plays the television loud which bothers other residents. Interviews conducted with residents revealed 4 out of 10 residents stated that there are no loud noises heard at the facility, 4 out of 10 residents were unable to provide information due to cognitive skills and 2 out of 10 residents stated that have heard loud noises that do not allow them to sleep or disturb them. Interviews conducted with staff revealed 9 out of 10 staff stated residents have not complaint about hearing loud noises at the facility and have not observed residents screaming or been loud. One (1) out of ten (10) staff stated to have heard a resident yelling at the facility which can be disturbing to others. Administrator stated that once the concern of the noise was brought up, the staff looked into it. However, the resident being accused of creating the noise cannot increase the volume in the TV on their own due to their physical/cognitive skills and does not have a behavior of scream.

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.

Regarding allegation: Staff do not answer resident’s call button in a timely manner. It is alleged staff assist resident an hour after call light has been pressed. Interviews conducted with residents revealed 5 out of 10 residents stated staff are prompt and available to assist in a short amount of time, 4 out of 10 residents were unable to provide answers due to their cognitive skills and 1 out of 10 residents stated that staff take over an hour to provide assistance with personal care. Interviews with staff revealed staff respond promptly to residents call light button. If staff are busy with other residents providing showers or bathroom assistance, staff notify the front desk via radio and another staff steps in at that time. (CONTINUED ON LIC 9099C)

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250220121232

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: 03/11/2025

NARRATIVE

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Per administrator the wait time is no more than 5 minutes to respond to a call light. During the facility’s tour LPA tested three call buttons and each was responded within less than 5 minutes. 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.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC9099 (FAS) - (06/04)

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