361880801-4-25-2022-18-AS-EMAN-CFET4C-20220615142339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 04/25/2022
Date Signed: 04/25/2022 02:00:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211108163107

FACILITY NAME:	JASMIN TERRACE AT YUCCA VALLEY		FACILITY NUMBER:	361880801
ADMINISTRATOR:	MICHAEL GARCIA		FACILITY TYPE:	740
ADDRESS:	55425 SANTA FE TRAIL		TELEPHONE:	(760) 365-0887
CITY:	YUCCA VALLEY	STATE: CA	ZIP CODE:	92284
CAPACITY:	85	CENSUS: 65	DATE:	04/25/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator Michael Garcia		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff does not treat residents with respect.
Staff uses derogatory terms.
Staff is creating a hostile environment.
Staff failed to assist resident after sustaining a fall.
There is an unclear staff working at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility 04/25/2022 at 11:00 AM for the purpose of delivering the findings to the above allegations. LPA Brown met with staff Priscilla Soto. LPA Brown explained the purpose of the visit and was granted entry. Administrator Michael Garcia met with LPA Brown during the visit.

The investigation was conducted by LPA Brown. LPA toured the facility, conducted interviews, and reviewed facility files. The first allegation indicates that staff does not treat residents with respect. During the investigation, LPA Brown was not able to obtain evidence to corroborate the allegation. LPA Brown interviewed twelve (12) residents and four (4) staff and interviews with staff and residents indicated that staff treat residents with respect.10 out of 12 residents stated that all staff treated them with respect.and

*** continuation on LIC 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

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 18-AS-20211108163107

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: JASMIN TERRACE AT YUCCA VALLEY	FACILITY NUMBER: 361880801
	VISIT DATE: 04/25/2022

NARRATIVE

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and 2 residents are not oriented and unable to answer LPA questions. LPA Brown interviewed 4 staff. 4 out of 4 staff stated that they treat all residents with respect.

The second allegation indicates that staff uses derogatory terms During the investigation, LPA Brown was not able to obtain evidence to corroborate the allegation. Interviews with staff and residents indicated that staffs do not use derogatory terms when they speak to the residents. 10 out of 12 residents reported that all staff speak to them nicely and with respect and no staff uses derogatory terms when they speak to them and 2 residents are not oriented and unable to answer LPA questions. LPA Brown interviewed 4 staff. 4 out of 4 staff stated that they never use derogatory terms when they speak to the residents.

The third allegation indicates staff is creating a hostile environment. LPA Brown was not able to obtain evidence to corroborate the allegation. Interviews with staff and residents indicated that staff are not creating a hostile environment to the residents. 10 out of 12 residents indicated that staff at the facility do not create a hostile environment to the residents. They reported that staff are nice to them, and they assist them if they need help or need something. LPA Brown interviewed 4 staff. 4 out of 4 staff stated that they never create hostile environment to the residents.

The fourth allegation indicates staff failed to assist residents after sustaining a fall. LPA Brown was not able to obtain evidence to corroborate the allegation. Interviews with staff and residents indicated that all staff helps resident after sustaining a fall. 10 out of 12 residents reported that all staffs help residents after sustaining a fall. LPA Brown interviewed four (4) staff. 4 out 4 staff stated that they always help residents after sustaining a fall.

The fifth allegation indicates there is unclear staff working at the facility. LPA Brown was not able to obtain evidence to corroborate the allegation. During the visit, LPA Brown checked all staff working at the facility and observed that all staff working have fingerprint clearance. LPA Brown interviewed four (4) staff and 4 out of 4 staff reported they need to have fingerprint clearance before they can start working at the facility.

***Continuation in LIC9099C***

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 18-AS-20211108163107

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: JASMIN TERRACE AT YUCCA VALLEY	FACILITY NUMBER: 361880801
	VISIT DATE: 04/25/2022

NARRATIVE

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Based on the information obtained and observation, there is not enough evidence to state Staff does not treat residents with respect (allegation #1), Staff uses derogatory terms (allegation #2), Staff is creating a hostile environment.(allegation #3), Staff failed to assist resident after sustaining a fall (allegation #4), and There is an unclear staff working at the facility (allegation # 5). Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time.

An exit interview was conducted, and a copy of this report (LIC 9099) was discussed and provided to Administrator Michael Garcia.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

LIC9099 (FAS) - (06/04)

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