361880801-3-13-2023-56-AS-KCLS-CQNNYU-20230407105316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 03/13/2023
Date Signed: 03/13/2023 01:50:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
02/22/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230222085840

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: 72	DATE:	03/13/2023
		UNANNOUNCED	TIME BEGAN:	12:38 PM
MET WITH:	Michael Garcia, Administrator		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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facility has bed bugs
facility's not clean and sanitary

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to continue the complaint investigation and deliver findings on above complaint allegations. LPA Malcore met with Administrator, Michael Garcia and discussed the purpose of the visit.

Regarding facility has bedbugs, LPA reviewed and obtained copies of service reports for pest control treatment at the facility. During the investigation, LPA observed staff moving furniture in resident's (R1) bedroom in preparation for bed bug heat treatment. R1 was relocated to another bedroom temporarily. LPA observed that R1’s temporary bedroom was clean and did not observe any insects. LPA observed that R1’s bathroom was clean and toilet functional. All five (5) residents interviewed did not observe bed bugs in the facility. Although the facility is experiencing a bed bug incident, they are taking appropriate steps to help mitigate the issue.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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-20230222085840

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: JASMIN TERRACE AT YUCCA VALLEY	FACILITY NUMBER: 361880801
	VISIT DATE: 03/13/2023

NARRATIVE

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Regarding facility is not clean and sanitary, LPA observed that the facility is clean and sanitary. LPA observed facility hallways are free of clutter. Licensee, four (4) staff, and five (5) residents were interviewed. All interviews deny that the facility is not clean and sanitary.

Based upon the investigation, the allegations are unsubstantiated. While the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. no deficiencies were cited at this time.

An exit interview was conducted, and a copy of this report was provided to Administrator, Michael Garcia at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

LIC9099 (FAS) - (06/04)

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