361880801-9-7-2022-56-AS-KCLS-CN2SE2-20230113124802

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 09/07/2022
Date Signed: 09/07/2022 05:21:10 PM

Substantiated

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
09/07/2022 and conducted by Evaluator Bernadette Allen

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220907102215

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: 76	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Michael Garcia Administrator		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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The licensee did not maintain a comfortable temperature in the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate a complaint investigation for the above-mentioned allegation. LPA met with Administrator Michael Garcia and discussed the purpose of the visit.

Allegation: The licensee did not maintain a comfortable temperature in the facility. LPA Allen toured the inside of the facility and observed two thermostats in the main dining area, one read 85 degrees, and the other read 90 degrees. The administrator informed LPA that he is currently working with an air conditioning company to get the air conditioning unit fully operational.
LPA observed one cooling fan at the reception area, two cooling fans in the dining area, two cooling fans in the kitchen area, and three cooling fans in the TV room. LPA toured eleven (11) residents’ rooms in assisted living and nine (9) resident rooms in memory care unit. All resident rooms that were toured did have working air conditioning units. Interviews conducted with six (6) residents and three (3) staff members all reported that the air conditioning unit is not working in the common areas nor in the main kitchen. The investigation revealed that the facility’s air conditioning unit is inoperable in common areas resulting in uncomfortable temperatures in the facility. This poses a potential Health and Safety risk to the clients in care.

Based on the interviews conducted with residents and facility staff LPA determined the mentioned allegation is Substantiated.

An exit interview was conducted where this report was discussed, and a copy of this report 9099, 9099D and appeal right was provided to Michael Garcia Administrator at the conclusion of the visit.

Substantiated

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: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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-20220907102215

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/08/2022 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities- Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.	1 2 3 4 5 6 7	The administrator agreed to provide CCL with a work contract to replace or repair the air conditioning unit and provide CCL with a plan of options to have resident meals in their rooms and/or areas where the AC unit is working until the unit is working.This POC is due by 9/8/2022.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews conducted with residents and facility staff. The facilities air conditioning unit is not working in the main common areas and the kitchen. This poses a potential Health and Safety risk to the clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC9099 (FAS) - (06/04)

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