361880801-12-9-2023-56-AS-KCLS-CYJRUW-20231215122036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 08/23/2023
Date Signed: 12/09/2023 02:21:46 PM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2023 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20230815162748

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: 68	DATE:	08/23/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Michael Garcia Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff did not adequately supervise residents resulting in residents engaging in physical altercations.
Staff did not ensure that facility air conditioning is working.
Staff did not ensure that doors were secured in the memory care unit of the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the mentioned allegations. LPA Allen met with Michael Garcia Administrator who was informed of the visit.
The investigation consisted of interviews with seven (7) residents, six (6) staff, and documents were reviewed. LPA obtained documents that revealed the air conditioning unit was replaced/repaired and LPA did feel cool air coming from the unit. LPA observed the thermostat at 70 degrees in the main area of the facility. LPA toured all rooms in the facility and all air conditioning units were working.
LPA toured the memory care unit inside and outside; LPA observed the unit locked and secure during the visit. The sliding doors in the memory care unit were observed to open and could only be opened to 10 inches documents were received confirming measurements. The outside area where sliding doors open is in a secure perimeter where residents can not get out. The interviews conducted with staff stated the altercation started in a resident’s room and a staff member did deescalate the situation, requested assistance from another staff member.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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-20230815162748

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
, CA 92507

FACILITY NAME: JASMIN TERRACE AT YUCCA VALLEY	FACILITY NUMBER: 361880801
	VISIT DATE: 08/23/2023

NARRATIVE

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Based on the interviews, staff were available at the time of the altercation and R1 was assisted with medical attention.

LPA also observed the lunch menu, toured the kitchen, and there appeared to be sufficient food supplies for the residents in care. LPA observed residents eating a balanced cooked lunch, Chili beans with vegetables and garlic bread, coffee, juice, or water.

Based on interviews conducted, documents reviewed and observations, the allegations above are unsubstantiated. A finding of unsubstantiated means although the allegations 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 with Michael Garci where the report was discussed and provided at the conclusion of the visit with appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC9099 (FAS) - (06/04)

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