361880801-11-16-2022-56-AS-KCLS-CLEPVC-20221122103851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:27:40 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
11/10/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20221110130446

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: 71	DATE:	11/16/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Michael Garcia-Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff gave marijuana products to residents in care without proper authorization
Staff yells at residents in care
Staff did not store food in a safe and healthful manner
Staff do not provide proper incontinence care to residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Bernadette Allen arrived at the facility unannounced to conduct a complaint investigation and deliver the findings for the complaint allegations listed above. LPA met with Administrator Michael Garcia.

During today’s visit, LPA Allen toured the facility, interviewed nine (9) staff members and nine (9) residents, and reviewed resident file.

Allegation #1-Staff gave marijuana products to residents in care without proper authorization. LPA Allen interviewed nine (9) staff members and nine (9) residents and found that staff member has not given marijuana products to the residents in care.

Allegation #2-Staff yells at residents in care. LPA Allen interviewed nine (9) staff members and nine (9) residents and LPA Allen found that staff members does not yell at residents in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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 56-AS-20221110130446

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: 11/16/2022

NARRATIVE

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Allegation #3- Staff did not store food in a safe and healthful manner. LPA Allen toured the kitchen and observed that the food was stored properly and there were no health and safety concerns.

Allegation #4- Staff do not provide proper incontinence care to residents in care. LPA Allen interviewed nine (9) staff members and nine (9) residents and based on the interviews with the staff and resident LPA found that staff does provide proper incontinence care to residents in care.

Based on observation, and interviews conducted, and record review the four (4) allegations listed above are deemed Unsubstantiated. A finding that a 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.

An exit interview was conducted, and this report and appeal rights was discussed and provided to Michael Garcia at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC9099 (FAS) - (06/04)

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