361880801-12-14-2021-18-AS-EMAN-CA5P89-20211228100508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 12/14/2021
Date Signed: 12/14/2021 12:22:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/27/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210927092059

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: 57	DATE:	12/14/2021
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Michael Garcia		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility Staff do not wear a mask
Facility is malodorous

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Melody Brown and Rohit Lama made an unannounced visit for the purpose of delivering the findings to the above allegations. The LPAs met with Dietary Supervisor and Assistant Administrator Maria Molina. LPAs explained the purpose of the visit and were granted entry. Administrator Michael Garcia arrived during the the visit.

LPAs Brown and Lama observed temperature checks at the entrance area of the facility, visitors were asked the screening questions, and all staff are wearing masks. In addition, LPAs Brown and Lama observed Covid-19 signages throughout the facility, sufficient hand sanitizers located in the common areas of the facility and social distancing are being implemented.

The first allegation indicates that facility staff do not wear a mask. During the investigation, LPAs Brown and Lama did not obtain evidence to corroborate the allegation. LPA Brown interviewed 8 residents and 6 staffs. *** continuation on LIC 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

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 18-AS-20210927092059

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: JASMIN TERRACE AT YUCCA VALLEY	FACILITY NUMBER: 361880801
	VISIT DATE: 12/14/2021

NARRATIVE

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6 out of 8 residents stated that staff always wore masks while at the facility and 2 residents are not oriented and unable to answer LPA questions. LPA Brown interviewed 6 staff. 6 out of 6 staff stated that they always wear mask and they were provided the necessary personal protective equipment (PPE).

The second allegation indicates that facility is malodorous. Interviews with staff and residents also indicated that the facility does not have malodorous smell. 6 out of 8 residents stated that facility does not have malodorous smell and 2 residents are not oriented and unable to answer LPA questions. LPA Brown interviewed 6 staff. 6 out of 6 staff stated that facility does not have malodorous smell. During today’s visit, LPAs Brown and Lama toured numerous parts of the facility, including common areas and several resident bedrooms, and did not observe any malodorous scent.

Based on the information obtained and observation, there is not enough evidence to state facility staff do not wear a mask (allegation #1) and facility is malodorous (allegation #2). Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time.

An exit interview was conducted, and a copy of this report (LIC 9099) was provided to Administrator Michael Garcia.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

LIC9099 (FAS) - (06/04)

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