361880801-7-31-2023-56-AS-KCLS-CV6USX-20230829155105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 07/31/2023
Date Signed: 07/31/2023 11:25:39 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
05/04/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230504153119

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: 73	DATE:	07/31/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Michael Garcia, Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff hit resident.
Staff not ensuring resident's needs are met by leaving residents in soiled diapers for extended periods.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver the findings on the above allegations. LPA met with Michael Garcia and explained the purpose of the visit.
The investigation consisted of LPA observations, interviews, and pertinent document review.

Regarding the allegation staff hit resident, the Administrator and staff interviewed deny hitting resident #1 (R1) and other residents. Residents interviewed deny staff hitting them nor have they witnessed staff hitting other residents. Facility file review reveals, R1 sustained injuries to the face when pulled by Resident #2 (R2) causing R1 to fall. Staff interviewed stated that they did not witnessed the incident and heard from Staff #1 (S1) that R1 sustained injuries to their face and buttocks when pulled by R2 causing R1 to fall. LPA made several attempts to contact S1 but they were unavailable to corroborate the allegation. R1 and R2 were unable to corroborate the allegation due to their cognitive condition. There is not enough evidence to corroborate this allegation.

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: 07/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023

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-20230504153119

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: 07/31/2023

NARRATIVE

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Regarding the allegation, staff not ensuring resident's needs are met by leaving residents in soiled diapers for extended periods, Administrator and staff interviewed deny leaving resident #1 (R1) and other residents in soiled diapers for extended periods. Staff interviewed stated that residents are checked every two hours for diaper changes. Staff interviewed deny seeing diaper rashes on residents due to being left in soiled diapers for extended period. Residents interviewed deny that staff left them in soiled diapers for an extended period. R1 was unable to corroborate the allegation due to their cognitive condition. There is not enough evidence to corroborate this allegation.

Based on file review, interviews and observations, the above allegations 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 with appeal rights was provided to Administrator 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: 07/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023

LIC9099 (FAS) - (06/04)

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