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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607655
Report Date: 02/24/2025
Date Signed: 02/24/2025 03:53:37 PM

Document Has Been Signed on 02/24/2025 03:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 MOLINOFACILITY NUMBER:
197607655
ADMINISTRATOR/
DIRECTOR:
VIRGINIA GARCIAFACILITY TYPE:
740
ADDRESS:245 S. EL MOLINO AVE.TELEPHONE:
(626) 578-0460
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY: 206TOTAL ENROLLED CHILDREN: 0CENSUS: 144DATE:
02/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:58 AM
MET WITH:Rocio Gonzalez - Wellness DirectorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Mary Flores conducted an annual inspection visit at the facility using the CARE inspection tool. LPA met with Rocio Gonzalez and explained the reason for the visit.

The facility is licensed to serve 206 residents over the age of 60 years old of which 171 may be non-ambulatory, 35 bedridden, and a hospice waiver for 20 hospice residents. There are currently 15 residents on hospice. Facility is a two story building in a residential area which consist of shared bedrooms, several common areas, a commercial kitchen, and a courtyard.
Facility cares for residents with dementia and has delayed egress on exit doors. There is a water feature in the courtyard. The water feature has a fence around the entire perimeter. Facility has a fire sprinkler system throughout the building.

Today's visit consisted of a tour of the facility (Physical Plant Domain) with Lori Lackey and medication review. LPA observed the following:
First floor common areas: Lobby, visitation room, dining rooms, activity room all have sufficient space with furniture in good repair, and fireplaces are covered. Commercial kitchen was observed clean, in good repair, and food supplies were observed sufficient for at least 2 days of perishables and 7 days of non-perishables. Fiver (5) random bedrooms were observed in the first floor; each room is furnished with the required furniture, with sufficient lighting, and bedding supplies. Bathrooms were observed in good repair. Water temperature was tested between 111.0 -116.4 degrees F., which is within the required 105-120 degrees F.

Second floor: Seven (7) random bedrooms were observed each room is furnished with the required furniture, with sufficient lighting, and bedding supplies. Bathrooms were observed in working condition. Water temperature was tested between 106.5 - 114.4 degrees F., which is within the required 105-120 degrees F. (CONTINUED LIC809C)
Tony VasalloTELEPHONE: (818) 419-8131
Mary G FloresTELEPHONE: (323) 981-3965
DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/24/2025
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Second floor: dining room has sufficient furniture and in good repair. Medication room was observed inaccessible to the residents.

Medication was reviewed for 10 residents.

LPA will return at a different time to continue the annual visit and complete the other domains.

No deficiencies were noted during this visit.

Exit interview was conducted with Virginia Garcia and a copy of this report.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC809 (FAS) - (06/04)
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