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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 07/15/2025
Date Signed: 07/15/2025 01:24:23 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/11/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250711143825
FACILITY NAME:JASMIN TERRACE AT EL MOLINOFACILITY NUMBER:
197607655
ADMINISTRATOR:VIRGINIA GARCIAFACILITY TYPE:
740
ADDRESS:245 S. EL MOLINO AVE.TELEPHONE:
(626) 578-0460
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY:206CENSUS: 143DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Virginia GarciaTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not prevent resident from being harmed by another resident.
Staff did not respond to resident's request for assistance in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Virginia Garcia and explained the reason for the visit.

The investigation consisted of the following: LPA conducted interviews with Staff 1-3 (S1-3) and Residents 1-6 (R1-R6). Attempts were made to interview Resident R7 who was unable to respond to questioning.
Interview was conducted with the Administrator.

LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1 and R7's facility file. LPA collected copies of Appraisal Needs and Services, Physician's Report, and Identification and Emergency Information.
Facility submitted Staff Log of Resident Room checks.

In regards to the allegation Staff did not prevent resident from being harmed by another resident, based on
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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 28-AS-20250711143825
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: JASMIN TERRACE AT EL MOLINO
FACILITY NUMBER: 197607655
VISIT DATE: 07/15/2025
NARRATIVE
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interviews conducted and information gathered it was revealed by Resident R1 that staff were not told that Resident R7 had hit her and spit on her.
Said that she yelled out help, but stated that staff were down the hall and helping other residents and might not have heard her.
Resident's R2- R6 all stated that staff are very good and they respond quickly when resident's need assistance. Said staff are very helpful.
Administrator stated that room checks are every 2 hours and staff has to always report it to the front desk that everyone is accounted for.
Staff Logs for 7/9/25 and 7/10/25 reveal the following:
7/9/25- Staff S1 checked Resident R1's room at 11:30, 1:35, 3:24, 6:16 and 7:00.
7/10/25- Staff S1 checked Resident R1's room at 11:39, 1:33, 3:35, 6:15 and 7:30.
Interview with Staff S1 who stated that Resident R1 and R7's room was checked all nite and always 1 staff in each corner of the facility and was close by and never heard a yell for help and pull cord was not pulled.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation Staff did not respond to resident's request for assistance in a timely manner. based on interviews conducted and information gathered Resident R1 stated that staff was not told about the incident with R7 afterwards and only told Social Worker.
Resident's R2- R6 all stated that staff are very good and they respond quickly when resident's need assistance. Said staff are very helpful. 1 resident witnessed a resident as was described as having a meltdown and right away a staff was there and walked with the resident and was very patient.
Administrator stated that room checks are every 2 hours and staff has to always report it to the front desk that everyone is accounted for.
Staff Logs for 7/9/25 and 7/10/25 reveal the following:
7/9/25- Staff S1 checked Resident R1's room at 11:30, 1:35, 3:24, 6:16 and 7:00.
7/10/25- Staff S1 checked Resident R1's room at 11:39, 1:33, 3:35, 6:15 and 7:30.
Interview with Staff S1 who stated that Resident R1 and R7's room was checked all nite and always 1 staff in each corner of the facility and was close by and never heard a yell for help and pull cord was not pulled.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.




NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2