361880801-6-15-2021-18-AS-JESL-CG8VBD-20220711161723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 06/14/2021
Date Signed: 06/15/2021 10:55:05 AM

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2021 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210427160206

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: 63	DATE:	06/14/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Administrator Michael Garcia		TIME COMPLETED:	01:31 PM

ALLEGATION(S):

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Staff took residents shower chair away resulting in resident not being able to shower.
Residents are being fed rotten food.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation and to deliver findings for the allegation(s) listed above. LPA was greeted by Dietary Services Director Maria Molina. Administrator arrived at the facility a few hours after LPA's arrival. The investigation consisted of a review of pertinent documentation and interviews.

Allegation: Staff took residents shower chair away resulting in resident not being able to shower.
LPA conducted interviews and reviewed documentation. R1 did in fact have a shower chair that was removed/packed, that was misplaced from when they were sent to a skilled nursing facility. However the facility did purchase a new shower chair, so that R1 could continue to take showers as often as they pleased. On 4/29/21, LPA conducted a virtual visit and observed there to be a shower chair in R1's bathroom. Additionally staff ended up locating the original shower chair that evening on 4/29/21. On 4/30/21 LPA observed the chair during a follow up virtual visit via Facetime, that the chair was in R1s possession. R1 also confirmed that it was their chair. The allegation of Staff took residents shower chair away resulting in resident not being able to shower is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

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-20210427160206

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
RIVERSIDE, CA 92507

FACILITY NAME: JASMIN TERRACE AT YUCCA VALLEY	FACILITY NUMBER: 361880801
	VISIT DATE: 06/14/2021

NARRATIVE

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Allegation: Residents are being fed rotten food.

LPA conducted interviews and observed the lunch being served was chicken, mashed potatoes and vegetables to be fresh, cooked and in good portion size. Interviews conducted the food is not always liked because some resident's do not prefer Mexican food and want take out instead, however the feedback stated was that the food was not rotten or found to not to be fresh. LPA toured the kitchen it was clean and organized. During interview conducted R1 stated that they sometimes save their meals for their cat by putting the plates under their bed, and there was a possibility that they had forgotten about it. This information was also confirmed by staff. Therefore the allegation of Residents are being fed rotten food is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted and a copy of this report was provided to Administrator Michael Garcia.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

LIC9099 (FAS) - (06/04)

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