197607655-4-23-2024-28-AS-TVAO-D59MQ7-20240514094814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 04/23/2024
Date Signed: 04/23/2024 02:22:29 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
01/11/2024 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240111160546

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:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	01:44 PM
MET WITH:	Lori Lackey Assistant Administrator		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Facility staff sexually abused resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted a subsequent complaint investigation visit regarding the above allegation. LPA met with Lori Lackey and explained the reason for the visit.

The investigation consisted of the following: On 1/16/24 LPA Flores conducted a health and safety check visit. LPA Flores obtained a copy of admission agreement for resident #1(R1) as other documents were collected on 1/11/24 during a case management visit. On 1/12/24 The Investigation Bureau Department (IB) assigned IB investigator Heidy Bendana to the investigation and conducted interviews with 5 staff, 2 residents, R1’s conservator, reviewed video footage, obtained medical records, and police report. On 4/23/24 LPA Flores conducted a visit at the facility and delivered findings.

The investigation revealed the following: Regarding allegation: Facility staff sexually abused resident while in care. It is alleged R1 claimed that staff member entered R1’s bedroom and sexually assaulted R1.
(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: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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-20240111160546

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: 04/23/2024

NARRATIVE

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On 1/8/24 R1 was found sleeping in the dining room and refused to sleep in own bedroom. On 1/9/24 Assistant administrator asked R1 why R1 refused to sleep in own room. R1 stated that staff #1(S1) kept entering R1’s room to sleep with R1. Assistant Administrator continue to ask more questions and R1 stated, “S1 raped me.” On 1/9/24 Facility’s administration team cross reported R1’s allegation of sexual assault by staff to community care licensing and local ombudsman. On 1/10/24 facility contacted local police department. Police officers responded to the report. R1 was send to the hospital to be evaluated. Interviews conducted revealed facility staff and R1’s conservator do not believe S1 raped R1. Facility staff stated that S1 does not go into residents’ room as S1 job does not require them to enter the rooms. S1 was observed leaving the facility the night of 1/8/24. S1 stated to not have been alone with R1 at any time and does not know why R1 would state that as S1 does not go to rooms alone. Documents reviewed revealed R1’s physician report dated 1/17/24 notes R1 as confused and in need of redirection due to mild cognitive skills. Police report dated 1/10/24 notes police officers responded to a call at the facility due to suspicious circumstances. Officers conducted interviews with administrator team, R1, and reviewed video footage at the facility, attempted to interview S1, no further investigation was reported by Pasadena Police Department. IB investigator reviewed facility’s video footage and observed R1 sleeping in the dining room on 1/8/24, R1 seem to be speaking to someone. However, there was no one there. S1 was observed leaving the facility at the end of the shift and no where near R1. Due to R1's cognitive skills and other interviews the allegation cannot be corroborate.

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 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: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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