361880801-4-26-2023-56-AS-KCLS-CT7Q2G-20230627114704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 04/26/2023
Date Signed: 04/26/2023 12:03:41 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
04/24/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230424105500

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: 75	DATE:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Maria Carrillo Molina, Dietary Supervisor		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Staff do not ensure safe personal hygiene while in the kitchen

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted a 10-Day complaint investigation at the facility. LPA Malcore met with Dietary Supervisor Maria Carrillo Molina an discussed the purpose of the visit. The investigation consisted of facility tour, interviews, obtaining and reviewing pertinent files and documents.

Regarding the allegation that staff do not ensure safe personal hygiene while in the kitchen, LPA toured the kitchen and observed all staff in the kitchen wearing mask, gloves, and hair nets. LPA did not observed any food left out and open. The kitchen was free of odors, kitchen counters and floors were clean. LPA reviewed staff files which reveal that staff is trained in safety protocals. Staff interviews deny that staff do not ensure safe personal hygiene while in the kitchen. Three (3) out of four (4) residents interviewed stated they have not witnessed staff not using safe personal hygiene while in the kitchen.

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: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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-20230424105500

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: 04/26/2023

NARRATIVE

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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited at this time.
An exit interview was conducted where the report was discussed and a copy of this report with appeal rights was provided to the Maria Carrillo Molina 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: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

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