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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 05/04/2026
Date Signed: 05/04/2026 10:32:52 AM

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
01/19/2021 and conducted by Evaluator Abdoulaye Zerbo
COMPLAINT CONTROL NUMBER: 18-AS-20210119115339
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: 62DATE:
05/04/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Janine LewisTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff verbally abused resident
INVESTIGATION FINDINGS:
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On 05-04-26, Licensing Program Analyst (LPA) Abdoulaye Zerbo made an unannounced visit to the facility to deliver findings on the above allegation. LPA met with Office Manager Janine Lewis and explained the purpose of the visit.
Regarding the allegation that staff verbally abused resident, It was alleged that staff 1 (S1) was verbally abusive with R1. Interviews with multiple staff members at the facility confirmed that S1 was verbally abusive to the residents in care. The facility conducted an internal investigation in regards to S1 yelling at R1 and the findings were deemed substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
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 5
Control Number 18-AS-20210119115339
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: 05/04/2026
NARRATIVE
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Based on interview statements and reviewed information, S1 engaged in inappropriate and abusive conduct toward R1 by poking the resident. The incident was serious enough that the family contacted law enforcement and the facility terminated S1 terminated from employment on 01-14-2021.

Based on record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code.

An exit interview was conducted, and a copy of this report, the 9099-D and the appeal rights were provided to Office Manager Janine Lewis

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20210119115339
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: 05/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2026
Section Cited
CCR
87413(a)(2)
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87413 (a)(2) Personnel – Operations
(a) In each facility: (2)Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice.
This requirement is not met as evidenced by:
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Licensee terminated and dissociated S1 from the facility
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Based on interviews and records review, the licensee did not comply with the section cited above. R1 was verbally abused by S1 while 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: Anthony Perez
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
01/19/2021 and conducted by Evaluator Abdoulaye Zerbo
COMPLAINT CONTROL NUMBER: 18-AS-20210119115339

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: 62DATE:
05/04/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Janine LewisTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Resident had unexplained bruises
Staff gave resident the wrong medication
Staff do not have training
Staff are not assisting resident with hygiene needs
Staff left resident in soiled diapers
INVESTIGATION FINDINGS:
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On 05-04-26, Licensing Program Analyst (LPA) Abdoulaye Zerbo made an unannounced visit to the facility to deliver findings on the above allegations. LPA met with Office Manager Janine Lewis and explained the purpose of the visit. LPA conducted interviews and records reviews in regards to the allegations listed below.
Regarding the allegation resident had unexplained bruises, it was alleged Resident 1 (R1) sustained multiple bruises on face, chin and wrist in November of 2020. LPA conducted interviews with facility staff and staff reported R1 received the bruises as a result of falls. Facility staff stated that R1 was very active and hung around with another resident who used to hold R1’s hand. According to facility staff, the residents walking together led to the falls. The investigation did not reveal documented falls for R1 until 2021. A review of R1’s physician report, needs and services plan and functional ability documents did not reveal that R1 was a fall risk. Attempts to interview R1 were unsuccessful. R1’s Physician Report dated 01-10-20 revealed R1 was ambulatory. The LPA was not able to interview caregivers who worked at the facility during the incident in question.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20210119115339
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: 05/04/2026
NARRATIVE
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Regarding the allegation that Staff gave resident the wrong medication. It was alleged that R1 was sent to the hospital because they were given another resident’s medication
LPA conducted interviews with facility staff and the information obtained revealed medication was dispensed as prescribed and do not recall any incidents where the wrong medication was administered to R1. Attempts to interview confidential witnesses for this allegation were not successful. Records to determine if R1 was given the wrong medication could not be obtained.
Regarding the allegation that staff do not have training. It was alleged that staff are not trained to care for individuals with dementia. LPA interviewed facility staff who stated the facility regularly conducts dementia in-service training. Staff training records in regards to dementia training could not be obtained.

Regarding the allegation staff are not assisting resident with hygiene needs. It was alleged that R1 has not been showered. LPA interviewed facility staff and the information obtained revealed that R1 was scheduled for showers twice a week, with additional showers provided as needed. Shower logs to determine if R1 was showered as schedule could not be obtained. Attempts to interview confidential witnesses for this allegation were not successful.


Regarding the allegation that staff left resident in soiled diapers. It was alleged that R1 had a soiled brief during a visit at the facility. LPA interviewed facility staff and the information obtained revealed that R1 received scheduled and as needed hygiene care. Attempts to interview confidential witnesses for this allegation were not successful. Records to determine R1’s two hour incontinence checks could not be obtained.

Based on interviews and records review, the allegations are unsubstantiated. A finding that the complaint is unsubstantiated means the preponderance of the evidence standard has not been met to prove the alleged violations occurred.

An exit interview was conducted, and a copy of this report was provided to Office Manager Janine Lewis

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5