361880801-7-7-2023-56-AS-KCLS-CV2R7L-20230825124631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 07/07/2023
Date Signed: 07/07/2023 10:52:22 AM

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
03/29/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230329091754

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: 77	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Michael Garcia, Administrator		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not ensure that staff are capable of communicating with residents
Staff do not ensure an adequate quantity of food is served to residents in care
Staff does not ensure transportation assistance is provided for residents
Residents were left in soiled diapers for extended periods of time
Resident left on the floor for an extended period of time
Staff speaks inappropriately to residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver findings on the above allegations. LPA met with Administrator, Michael Garcia and discussed the purpose of the visit. The investigation consisted of observations, reviewing pertinent documents, and interviews with relevant parties.

Allegation #1 – facility does not ensure that staff are capable of communicating with residents. Administrator and staff interviewed deny not being capable of communicating with residents. Residents interviewed deny that there is a communication barrier with staff.

Allegation #2 - staff do not ensure an adequate quantity of food is served to residents in care. LPA toured the facility kitchen and observed a sufficient supply of nonperishable foods and perishable foods for residents in care. LPA observed that menus consisted of a variety of meals for breakfast, lunch, and dinner. The Administrator and staff interviewed deny not ensuring residents are served an adequate quantity of food.

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: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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 2

Control Number 56-AS-20230329091754

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: 07/07/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Administrator stated that residents are provided three meals a day, snacks are provided to residents between meals. Residents interviewed stated that they are provided adequate quantity of food.

Allegation #3 - staff does not ensure transportation assistance is provided for residents. Administrator and staff interviewed deny not ensuring transportation assistance for residents. The Administrator stated that the facility arranges transportation for the residents using a dedicated driver, other staff, and third-party transportation services. Residents interviewed deny that the facility does not ensure transportation assistance when needed.

Allegation #4 – residents were left in soiled diapers for extended periods of time. Administrator and staff interviewed deny that residents are left in soiled diapers for extended periods. Staff interviewed stated that residents are check every (2) hours to assist with their needs. Residents interviewed deny that staff leave them in soiled diapers for long periods of time.

Allegation #5 – resident left on floor for an extended period of time. Administrator and staff interviewed deny that resident #1 (R1) was left on the floor for an extended period. R1 stated that they did fall at night and called for help. R1 stated that staff quickly arrived to assist them and was taken to the hospital.

Allegation #6 - staff speaks inappropriately to residents. Administrator and staff interviewed deny speaking inappropriately to residents. Residents interviewed deny that staff have spoken inappropriately to them.

Based on evidence obtained during this investigation, the allegations above are 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 where this report was discussed, and a copy of this report was provided to the Administrator 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: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2