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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880801
Report Date: 02/02/2022
Date Signed: 02/02/2022 02:26:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 VALLEYFACILITY NUMBER:
361880801
ADMINISTRATOR:MICHAEL GARCIAFACILITY TYPE:
740
ADDRESS:55425 SANTA FE TRAILTELEPHONE:
(760) 365-0887
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:85CENSUS: DATE:
02/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Maria MolinaTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility 02/02/2022 at 10:40 AM to conduct a health and safety check. LPA Brown identified herself and discussed the purpose of the visit with receptionist Priscilla Soto. Assistant Administrator and Dietary Supervisor Maria Molina was contacted and arrived at the facility and LPA Brown explained the purpose of the visit due to complaint # 18-AS-20220128162918.

Residents in care were present during visit. No imminent health and/or safety concerns observed at the time of visit. LPA Brown observed no health and/or safety hazards inside the facility. LPA Brown inspected the outside perimeter of the facility and observed no health and/or safety hazards. LPA Brown observed sufficient staff present at the facility to provide care. LPA Brown inspected facility food supplies and observed more than two (2) days supply of perishable foods and more than seven (7) days supply of non-perishable foods. The needs of the residents in care appears to be met during this inspection.

An exit interview was conducted where this report (LIC809) was discussed and provided to Assistant Administrator and Dietary Supervisor Maria Molina.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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