361880801-8-18-2026-56-AS-EMAN-DXGQS2-20260831122449

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880801
Report Date: 08/18/2026
Date Signed: 08/18/2026 12:25:40 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
02/14/2025 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250214143236

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: 64	DATE:	08/18/2026
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Maria Molina		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Resident sustained multiple fractures and injury while in care
Staff did not seek timely medical attention for a resident
Staff caused a resident's medical insurance to lapse

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver the complaint investigation findings regarding the above allegations. After introducing and identifying herself, LPA met with Assiting Administrator, Maria Marima, to discuss the investigation findings.

On February 14, 2025, the Department received a complaint regarding Resident #1 (R1) and the above allegations. The Department conducted an investigation, which included a review of facility files and other relevant records, observations, and interviews with R1, facility staff, residents, and other pertinent individuals.

Regarding allegation#1, resident sustained multiple fractures and injury while in care, on February 13, 2025, at approximately 2:39 am, facility staff observed R1 lying in blood in their room during a routine check. Staff immediately contacted Emergency Medical Services (EMS), and R1 was transported to the hospital for evaluation and treatment.
**continued on LIC9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026

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 56-AS-20250214143236

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
	VISIT DATE: 08/18/2026

NARRATIVE

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Hospital records documented that R1 was evaluated at approximately 3:33 am, and was diagnosed with fractured ribs, a fractured finger, a brain and rectal bleeding. The Department reviewed medical records and interviewed pertinent individuals regarding the reported injuries. The available records indicated that the rib fractures were associated with an older injury and that no recent trauma was identified. The brain bleeding was documented as nontraumatic, and no head injury was observed. The rectal bleeding was attributed to an underlying medical condition.

Records also documented a prior injury to R1’s pinky finger. On August 5, 2022, R1 reportedly injured the finger after it became caught on a bottle. R1 was transported to the hospital, and facility staff documented the incident. A medical record dated December 18, 2023, documented a curved pinky finger on R1’s left hand.

During the investigation, R1 was unable to recall how the injuries occurred and stated that the broken finger had occurred more than one month earlier. Interviews with R1 and pertinent individuals indicated that R1 had previously fallen outside of the facility and did not report the fall to facility staff or request assistance at the time. R1 recalled going to the hospital shortly after the fall. R1 did not report experiencing pain or sustaining an injury to facility staff. Resident and staff interviews revealed that residents have call buttons available in their rooms and that staff respond timely when residents use their call buttons for assistance.

Based on the evidence obtained during the investigation, the Department was unable to corroborate that R1 sustained the identified injuries because of staff neglect while in care.

Regarding allegation #2, Staff did not seek timely medical attention for a resident. On February 13, 2025, at approximately 2:39 am, staff observed R1 lying in blood in R1’s room during a routine check.

**continued on LIC9099-C**

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20250214143236

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
	VISIT DATE: 08/18/2026

NARRATIVE

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Staff immediately contacted EMS, and R1 was transported to the hospital for medical evaluation. Hospital records documented that R1 received medical treatment.

The investigation did not identify evidence that facility staff were aware of R1’s injuries prior to discovering R1 during the routine check or that staff delayed obtaining medical assistance after discovering R1’s condition. Resident and staff interviews indicated that residents have access to call buttons and that staff respond timely to assist.

Based on the evidence obtained, the Department was unable to corroborate that facility staff failed to obtain timely medical attention for R1.

Regarding allegation #3, staff caused a resident's medical insurance to lapse, the Department interviewed two facility staff members regarding the allegation that staff caused R1’s medical insurance to lapse. Both staff denied causing R1’s insurance to lapse. R1 was also interviewed and did not identify any facility staff member as having caused the lapse in insurance coverage.

Based on the evidence obtained during the investigation, the Department was unable to corroborate that facility staff caused R1’s medical insurance to lapse.

Based on the Department's investigation, there is not enough evidence to corroborate that the alleged violations occurred, therefore the allegations are Unsubstantiated. A finding of unsubstantiated means there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Assisting Administrator Molina, during which the investigation findings were discussed. A copy of this report and appeal rights was provided at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026

LIC9099 (FAS) - (06/04)

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