361880801-10-14-2021-18-AS-EMAN-C8ZSZ7-20211122131839

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 10/14/2021
Date Signed: 10/14/2021 03:12:20 PM

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/24/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210924093532

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: 59	DATE:	10/14/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Maria Molina		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are not following the proper protocols for COVID 19.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to commence a complaint investigation as well as to deliver findings for the allegation listed above. LPA met with Administrator Michael Garcia and Dietary Supervisor and Assistant Administrator Maria Molina. The investigation consisted of file review, interviews with staff and residents as well as LPA Brown's observation.

The investigation, which consisted of interviews and document reviews revealed the following:

LPA Brown observed temperature checks at the entrance area of the facility, visitors were asked the screening questions, and all staff are wearing masks. In addition, LPA Brown observed Covid-19 signages throughout the facility, sufficient hand sanitizers located in the common areas of the facility and social distancing are being implemented. During the investigation, LPA Brown did not obtain evidence to corroborate the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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 18-AS-20210924093532

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
RIVERSIDE, CA 92507

FACILITY NAME: JASMIN TERRACE AT YUCCA VALLEY	FACILITY NUMBER: 361880801
	VISIT DATE: 10/14/2021

NARRATIVE

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LPA Brown interviewed 8 residents and 6 staffs. 6 out of 8 residents stated that all staff wore masks, gowns, gloves, practice social distancing while at the facility and 2 residents are not oriented and unable to answer questions. LPA Brown interviewed 6 staff. 6 out of 6 staff stated that they were provided the necessary personal protective equipment (PPE) and were provided training on donning and doffing PPE and covid prevention. Interviews with staff and residents also indicated that residents with Covid were quarantined and isolated and no staff goes in and out of the memory care unit and to the assisted living side of the facility after being exposed to residents who have covid.

Based on the information obtained and observation, there is not enough evidence to state staff are not following the proper protocols for Covid-19. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time.

An exit interview was conducted, and a copy of this report was reviewed with and provided to Dietary Supervisor and Assistant Administrator Maria Molina. Administrator MIchael Gracia is unavailable due to scheduled Technical Assistance (TA) Visit.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC9099 (FAS) - (06/04)

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