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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880801
Report Date: 02/23/2021
Date Signed: 02/23/2021 10:44:24 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 VALLEYFACILITY NUMBER:
361880801
ADMINISTRATOR:MICHAEL GARCIAFACILITY TYPE:
740
ADDRESS:55425 SANTA FE TRAILTELEPHONE:
(760) 365-0887
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:85CENSUS: 60DATE:
02/23/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee Virginia GarciaTIME COMPLETED:
09:15 AM
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On 2/22/21, the department received information regarding the facility. Due to the nature immediate attention was required. On 2/23/2021 Licensing Program Analyst (LPA) Javina George and Licensing Program Manager (LPM) Joel Esquivel conducted an announced informal meeting. In attendance was Licensee Virginia Garcia, Administrator Michael Garcia, and Assistant Administrator Jennifer Levesque, and Nutritionist Maria Molina via Zoom due to COVID-19.

The informal meeting consisted of discussion of the following concerns:
Staffing issues: per the Licensee Virginia the facility has had a high turnover since the facility had the fire in December 2019. As a result there has been an increase in incidences. Virginia stated that, that was not the case that every resident case is individual, with their own needs and the residents will be monitored and assessed accordingly.

Physical plant repairs:
There is possible mold growing in the ceiling. Licensee stated that the facility was in the process of having renovations done, however due to covid-19, there has been a delay in the work being completed.
Heating and cooling system is not functional. It was explained that the system does work and the thermostat will be adjusted to promote a more comfortable temperature throughout the facility.
The bedrooms are not in the best condition. The renovations include having the carpet removed in the bedrooms and having new flooring put in. The rooms will additionally will have additional cleaning.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/23/2021
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There are bed bugs and roaches throughout the facility. There were specific rooms identified that were confirmed to have bed bugs. The facility is currently in the process of treating all rooms as a precaution. using a measures such as a heating device and are reportedly working with the an extermination company.

Food: The facility will continue to monitor and note residents that have Doctor's order indicating dietary restrictions.
An exit interview was conducted and a copy of this report was provided to Licensee Virginia Garcia and Administrator Michael Garcia.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021
LIC809 (FAS) - (06/04)
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