361880801-1-11-2024-56-AS-KCLS-D3SLJ7-20240328084728

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 01/11/2024
Date Signed: 01/11/2024 03:11:10 PM

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
01/08/2024 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240108141506

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: 69	DATE:	01/11/2024
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Maria Molina, Assistant Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not assist resident with incontinence needs

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 conduct a complaint investigation. LPA met with Maria Molina, Assistant Administrator and discussed the purpose of the visit.

Regarding the allegation, staff do not assist resident with incontinence needs, staff interviewed deny not assisting a resident with incontinence needs, Four (4) out of (6) residents interviewed deny that staff are not assisting them with their incontinence needs.

Based on LPA observations and interviews conducted, the allegation is Unsubstantiated; 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. No deficiencies were cited.

An exit interview was conducted where this report was discussed, and a copy was to provided to Maria Molina at the conclusion of the visit.

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: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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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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
01/08/2024 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240108141506

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: 69	DATE:	01/11/2024
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Maria Molina, Assistant Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure resident is bathed

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 conduct a complaint investigation. LPA met with Maria Molina, Assistant Administrator and discussed the purpose of the visit.
Regarding the allegation, staff do not ensure resident is bathed, Interviews with staff #1(S1) and staff #2 (S2) reveal they were told by resident #1 (R1) that they have not received their scheduled bath. Staff #1 stated that a bed bath was provided to (R1) after Christmas but did not remember the specific date. LPA review of daily care logs reveal no record of baths for R1 from 12/27/23 through 1/08/2024.
Based on LPA record review and interviews conducted, the allegation is Substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.
A Deficiency was cited per Title 22, Division 6, of the California Code of Regulations.
An exit interview was conducted where reports LIC9099 and LIC9099-D were discussed and copies with Appeal Rights were provided to Maria Molina at the conclusion of the visit.

Substantiated

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: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 56-AS-20240108141506

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/26/2024 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	87464 Basic Services(f) Basic services shall at a minimum include:(4)Personal assistance and care as needed by the resident...with those activities of daily living such as dressing, eating, bathing...this requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator shall conduct an in-service staff training regarding bath and shower care and submit proof of training to Licensing Agency by POC date.
	8 9 10 11 12 13 14	interviews with staff #1(S1) and staff #2 (S2) reveal they were told by resident #1 (R1) that they have not received their scheduled bath. review of daily care logs reveal no record of baths for R1 from 12/27/23 through 1/08/2024,which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

LIC9099 (FAS) - (06/04)

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