361880801-1-16-2026-18-AS-CTUA-DQM298-20260123161130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 01/16/2026
Date Signed: 01/16/2026 10:13:16 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
02/19/2021 and conducted by Evaluator Janette Romero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210219134833

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: 61	DATE:	01/16/2026
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Assistant Administrator Maria Molina		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Staff neglect resulted in resident’s death

INVESTIGATION FINDINGS:

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On 01/16/2026, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility to deliver findings regarding the allegation listed above. LPA met with Assistant Administrator (AA) Maria Molina who was informed of the purpose of the visit.

The department investigated the complaint of staff neglect resulted in resident’s death. The investigation consisted of interviews and records review.

It was alleged staff neglect resulted in Resident #1 (R1) falling, hitting their head and ultimately passing away. R1 succumbed to the injury from the fall and passed away on 05/02/2020.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

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-20210219134833

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: JASMIN TERRACE AT YUCCA VALLEY	FACILITY NUMBER: 361880801
	VISIT DATE: 01/16/2026

NARRATIVE

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Based on staff interviews it was revealed R1 transferred to another licensed facility and later returned to this facility, Jasmin Terrace of Yucca Valley. Overall, interviews revealed, that the facility was short-staffed at the time of this incident.

Initially it was alleged the fall was unwitnessed. However, during the course of the investigation a witness was identified. Staff reported hearing R1 call out for help. As staff was walking towards R1 to provide the assistance, they witnessed R1 fall to the floor and suffer the laceration. Staff immediately called 9-1-1 and R1 was transported to the hospital.

Staff interviews further revealed a change in condition of R1. R1 went from being independent and needing minimal assistance with activities of daily living to being described as “lethargic, and more medicated”. An updated Needs and Services plan was completed on 04/08/2020. The updated plan noted R1 to be a fall risk, due to poor safety awareness. Frequent checks were reported to have been implemented as an intervention method. Overall, interviews with staff revealed a staff shortage and staff not being properly trained.

Therefore, the allegation of staff neglect resulted in resident’s death is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, and a copy of this report, LIC 9099-C, Confidential Names list (LIC 811), and appeal rights were reviewed and provided to AA Molina.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

LIC9099 (FAS) - (06/04)

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