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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 02/12/2026
Date Signed: 02/12/2026 12:20:22 PM

Substantiated


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
02/14/2025 and conducted by Evaluator Eldin Serrano
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250214135233
FACILITY NAME:JASMIN TERRACE AT YUCCA VALLEYFACILITY NUMBER:
361880801
ADMINISTRATOR:MICHAEL GARCIAFACILITY TYPE:
740
ADDRESS:55425 SANTA FE TRAILTELEPHONE:
(760) 365-0887
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:85CENSUS: 61DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Michael Garcia, AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff did not provide resident's authorized representative with resident's records.
INVESTIGATION FINDINGS:
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On 2/12/2026, Licensing Program Analysts (LPA) Eldin Serrano visited the facility to investigate the above-mentioned allegation and deliver findings. LPA met with the administrator Michael Garcia to discuss the purpose of the visit. The investigation consisted of interviewing relevant parties and record reviews.

The allegation indicates that the facility staff did not provide resident's authorized representative with resident's records. – Based on interviews with relevant parties and file review, the facility did not provide the documents requested upon the resident's written consent or that of her designated representative within the time allowed by the regulation..

Based on interviews and file review, the preponderance of evidence standard has been met, therefore, the allegation is substantiated under the California Code of Regulations (Title 22, Division 6 & Chapter 8).

An exit interview was conducted, where this report, LIC9099, LIC9099D along with appeal rights, were provided to the administrator Michael Garcia.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20250214135233
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/18/2026
Section Cited
CCR
87506(c)(1)
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Title 22, Division 6 Chapter 8 Article 09. Resident Records(c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible...for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement is not met as evidence by:

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Licensee agreed to read regulation 87506 in its entirety and submit a statement of understanding to follow the regulation above by plan of correction (POC) due date.
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Based on interviews and file reviews, the licensee did not comply with the section cited above by not ensuring that the licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative which poses a potential health, safety or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2