361880801-4-3-2023-56-AS-KCLS-CRYVLZ-20230519163247

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 04/03/2023
Date Signed: 04/03/2023 02:07:11 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
02/21/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230221161840

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: 74	DATE:	04/03/2023
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Michael Garcia, Administrator/Licensee		TIME COMPLETED:	01:44 PM

ALLEGATION(S):

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Staff mismanage residents' medication
Staff failed to provide a safe and comfortable environment for residents
Untrained staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to continue the complaint investigation and deliver findings on the above allegations. LPA met with Licensee/Administrator, Michael Garcia and discussed the purpose of the visit. The investigation consisted of interviews with residents, staff, and document review.

Regarding the allegation that staff mismanage residents' medication, interviews with staff deny spilling residents’ medication, giving discontinued medication, and giving double dosages to residents in care. Three (3) residents interviewed deny that staff has mismanaged their medications. One (1) resident interviewed stated that they do not take medication. Interviews with staff reveal that two (2) medical technicians (MedTechs) count the medication prior to administering the medication to the resident to ensure that the proper dosage is given. Interviews with staff reveal that discontinued medication is logged, packaged, and returned to the pharmacy.

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: 04/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

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-20230221161840

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: 04/03/2023

NARRATIVE

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LPA reviewed the Medication Administration Record log (MAR) which does not corroborated the allegation of mismanagement. LPA observed that the medication room and centrally stored medication cabinets are locked. LPA observed that the MedTechs carry the key on their lanyard.

Regarding the allegation that staff failed to provide a safe and comfortable environment for residents, all staff interviews deny not providing a safe and comfortable environment for the residents. All residents interviewed stated that staff provides a safe and comfortable environment to residents in care.

Regarding the allegation of untrained staff, All resident interviews deny that staff is untrained. Interviews with staff reveal that staff have received training or are being trained in medication. Interview with staff #3 (S3) reveals that S3 is receiving hands-on medication training while being shadowed by a MedTech. LPA reviewed documentation of staff training.

Based on interviews and documents reviewed during the investigation, the above allegations are Unsubstantiated. Unsubstantiated meaning that 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 a copy of this report was provided to the Licensee/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: 04/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

LIC9099 (FAS) - (06/04)

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