361880801-12-14-2021-18-AS-EMAN-CAFQTP-20220107112729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 12/14/2021
Date Signed: 12/14/2021 12:58:45 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
09/30/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210930082659

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:	01:20 PM

ALLEGATION(S):

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Staff do not wear Personal Protective Equipment
Facility has pests
Facility not maintained clean and sanitary

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Melody Brown and Rohit Lama made an unannounced visit to the facility to deliver findings for the allegation(s) listed above. LPAs met with Dietary Supervisor and Assistant Administrator Maria Molina and Administrator Michael Garcia. The investigation consisted of file review, interviews with staff and residents as well as observation.

The first allegation indicates that staff do not wear personal protective equipment (PPE). During the investigation, LPA Brown did not obtain evidence to corroborate the allegation. LPA Brown interviewed 8 residents, 6 staffs and observed the facilities supply of PPE's for resident and staff use. 6 of 8 residents reported that staff wears PPE and 6 of 6 staff reported that they wore PPE all the time. In addition, LPAs Brown and Lama observed staffs wearing PPE. LPA Brown checked and determined that the facility had an ample supply of face masks, hand sanitizer, gloves and gowns for use. The quantity of the supplies met with the recommended 30-day supply to have available.
*** 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-20210930082659

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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The second allegation indicates that facility has pests. The investigation consisted of the following: LPA Brown interviewed Administrator Michael Garcia, Dietary Supervisor and Assistant Administrator Maria Molina. 8 residents, 6 staffs and reviewed pest control reports/invoice.

The investigation revealed the following: Administrator Michael Garcia said they have a pest control company who comes to the facility monthly to treat for pests. LPA Brown reviewed the pest control invoice and observed the pest control technician does treat the facility monthly. Administrator Michael Garcia and Dietary Supervisor and Assistant Administrator Maria Molina both state the pest control technician has not found any rodent droppings or any evidence of rodent activity in the facility. Moreover, 8 residents and 6 staffs were interviewed and 6 of 8 residents and 6 of 6 staffs have not seen any rodents in their rooms or at the facility, nor have they seen any rodent droppings.

LPA Brown reviewed the pest control report, and it says they have not found any signs of a rodent infestation.
Based on interviews conducted by LPA Brown and review of the pest control report, LPAs Brown and Lama did not obtain evidence to corroborate the allegation.

The third allegation indicates facility not maintained clean and sanitary. LPAs Brown and Lama did not obtain evidence to corroborate the allegation. Interviews with residents and staff denied that the facility’s not maintained clean and sanitary as the facility staff clean the premises on a regular basis. 6 of 8 residents and 6 of 6 staffs reported that the facility is always clean. LPAs Brown and Lama toured the physical plant, including the yard, and observed that the premises are clean and sanitary.

Based on the information obtained, there is not enough evidence to state staff do not wear personal protective equipment (PPE) (allegation #1), facility has pests (allegation #2) and facility not maintained clean and sanitary (allegation #3). Although the allegations may have happened or are 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.

No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report (LIC9099) was reviewed with and 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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