361880801-1-26-2023-56-AS-KCLS-CPGVVZ-20230228154706

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 01/26/2023
Date Signed: 01/26/2023 01:24:25 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
01/20/2023 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20230120164232

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: 70	DATE:	01/26/2023
		UNANNOUNCED	TIME BEGAN:	12:37 PM
MET WITH:	Michael Garcia. administrator		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff pushed resident
Staff verbally abuse resident
Staff did not administer residents medication
Staff did not prevent resident from burinng face
Staff are not treating resident with respect

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 allegations listed above. LPA met with Administrator Michael Garcia.

LPA interviewed resident one (1) who said that staff members have not physically, verbally abused or disrespect them. (R1) said that they were mad and missed their family down the hill. (R1) said that their medications were given to them daily but through them away in the trash because they wanted to leave the facility. Records reviewed also showed that (R1) was given their medications daily. (R1) was asked if the staff tried to stop them from burning their face and (R1) said yes but they wouldn't allow them to get close (R1) also stated that staff does threat them with respect.

Interviews were conducted with four (4) staff members who said staff did try to provide assistance to (R1) but (R1) would not allow anyone to get close enough to stop them from burning themself.

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: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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-20230120164232

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: 01/26/2023

NARRATIVE

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Based on observations, documentation and interviews the (5) five allegations are Unsubstantiated

A finding of unsubstantiated means although the allegations 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 discussed with Michael Garcia who was provided with a copy of the report with appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC9099 (FAS) - (06/04)

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