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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 07/31/2025
Date Signed: 07/31/2025 05:06:29 PM

Substantiated


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
07/29/2025 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250729153617
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: 141DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Virginia Garcia, Executive DirectorTIME COMPLETED:
05:10 PM
ALLEGATION(S):
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Staff are not ensuring resident exercises.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint visit to investigate the above allegation. The purpose of the visit was discussed with Assistant Executive Director Lori Lackey. Executive Director Virginia Garcia arrived later.

The investigation consisted of: LPA conducted a physical plant tour of common areas, activity areas, and dining room breakfast and lunch meal times. Residents (R1- R12), staff (S1-S9), and Home Health Director were interviewed. Record review was completed. Copies of relevant documents were obtained.

*See LIC9099C for report summary.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
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 5
Control Number 28-AS-20250729153617
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: 07/31/2025
NARRATIVE
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Allegation: Staff are not ensuring resident exercises. It is alleged that resident (R1's) was ordered by a physician to participate in daily exercise after recent medical issue, but on Friday, July 25, 2025 the resident was not observed in the 10:30 AM exercise class. An interview with R1 was attempted, but due to cognitive impairment they were not able to give feedback pertaining to the allegation. A total of 12 residents were interviewed. They confirmed exercise class is offered daily in the morning. A total of nine (9) staff were interviewed. Staff interviews revealed that resident (R1) is supposed to attend daily exercise classes at 10:30 AM, but sometimes the resident does not attend because staff are not escorting the resident to the exercise activity room. Staff stated that the resident is usually a late riser and eats breakfast close to 9:30 AM. During today's visit, LPA observed the exercise class begin at 10:30 AM. At 10:43 AM, resident (R1) was observed sitting by themselves in the dining room table. There was no food in front of the resident. Dining staff stated the resident was done with their meal at 10:15 AM. Resident (R1's) home health agency was contacted. The agency director said that the resident was discharged from physical therapy services on July 10, 2025. Home health representative stated that 2 facility staff were notified that R1 should join daily activities and group exercises, and should be encouraged to walk daily with supervision and use of walker. There is sufficient evidence to support the allegation.

Based on interviews, observation, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency is being cited according to Title 22. See LIC 9099D.

Exit interview was conducted with Executive Director Virginia Garcia. A copy of the report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20250729153617
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2025
Section Cited
CCR
87464(d)
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Basic Services. A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources.
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Executive Director agreed to develop a plan of action on how facility will meet all resident's basic needs. Plan shall include staffing, staffing responsibilities, and facility procedures.

Submit plan and proof of staff training.
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Based on interviews, observation, and record review resident (R1) was not escorted to exercise class on 7/25/25 and today (7/31/25). Per home health orders R1 requires daily exercise participation. The Appraisal/Needs and Services Plan states R1 is to be escorted to activities. This poses a potentila health, safety, and personal rights risk.
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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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/29/2025 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250729153617

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: 141DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Virginia Garcia, Executive DirectorTIME COMPLETED:
05:10 PM
ALLEGATION(S):
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Staff are not meeting residents showering needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint visit to investigate the above allegation. The purpose of the visit was discussed with Assistant Executive Director Lori Lackey. Executive Director Virginia Garcia arrived later.

The investigation consisted of: LPA conducted a physical plant tour of common areas, activity areas, and dining room breakfast and lunch meal times. Residents (R1- R12), staff (S1-S9), and Home Health Director were interviewed. Record review was completed. Copies of relevant documents were obtained.

*See LIC9099C for report summary.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20250729153617
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: 07/31/2025
NARRATIVE
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Allegation: Staff are not meeting residents showering needs. The complaint alleges resident (R1) is supposed to get three showers per week but it in recent weeks it was observed that the resident's hair was dirty, not combed, and their body wash had not been used. A total of nine (9) staff were interviewed. All staff said that residents are showered three times a week. Review of shower assignment indicates R1 is showered Monday, Wednesday, and Fridays. According to staff, R1's responsible party recently requested the resident be showered four times per week, and in recent weeks the resident has been showered on Sundays as well. A total of 12 residents were interviewed. The majority of residents have cognitive impairment. One (1) resident stated they are not showered. Resident (R1) was not oriented to time and place. The resident was well groomed and was last showered yesterday. Observation of residents, record review, and interviews conducted did not support the allegation.

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

An exit interview was conducted and a copy of this report was discussed and provided to Virginia Garcia.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5