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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 07/03/2025
Date Signed: 07/03/2025 03:06:18 PM

Substantiated


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
08/22/2024 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240822152146
FACILITY NAME:JASMIN TERRACE AT YUCCA VALLEYFACILITY NUMBER:
361880801
ADMINISTRATOR:MICHAEL GARCIAFACILITY TYPE:
740
ADDRESS:55425 SANTA FE TRAILTELEPHONE:
(760) 365-0887
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:85CENSUS: 61DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Michael GarciaTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff did not keep facility free of insects
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to conduct a complaint investigation on the above allegation. After identifying self, LPA met with Administrator, Michael Garcia and informed the purpose of the visit.

Regarding the allegation, staff did not keep facility free of insects, interviews with the five (5) staff reveal that that they have observed bed bugs in the facility. Staff interviews and documentation reveal that on 6/30/2025, room #133 in memory care was chemically sprayed for bed bugs. On the same day (6/30/2025) all rooms in memory care were chemically sprayed as a preventative measure. Rooms with minimal bed bug activity is sprayed and then deep cleaned. Rooms with high levels of bed bugs are heat treated and deeped cleaned. The heat treatment equipment is currently stored at the corporate facility in Pasadena. Five (5) out of (7) residents interview reveals that they have observed bedbugs in their bedrooms and bed bugs were treated by facility staff. Review of facility files reveals from June 2024 until June 2025, the facility has treated resident's bedrooms and common areas several times for bedbugs. LPA was not provided documentation of a professional extermination company treating for bed bugs. In addition, LPA observed several dead insects in room #107's shower.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 56-AS-20240822152146
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: 07/03/2025
NARRATIVE
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Based on investigation findings, the facility is not utilizing effective measures to control the spread of bed bugs; therefore, the allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to Administrator Garcia at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20240822152146
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2025
Section Cited
HSC
87303(a)
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87303Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors…this requirement is not met as evidenced by:
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The Administrator/Licensee has agreed to have an exterminator company conduct an inspect resident bedrooms, common areas, and treat rooms if bed bugs are observed & clean room 107's shower by POC due date.
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Interviews with staff, residents, and document review reveal that the facility does have bed bugs and the Licensee is not utilizing effective measures to mitigate the spread of bed bugs. This poses/posed an immediate health, safety, and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3