197607655-8-18-2025-28-AS-WSHO-DKYTXT-20250828150737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 08/18/2025
Date Signed: 08/18/2025 05:02:56 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
08/13/2025 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20250813111621

FACILITY NAME:	JASMIN TERRACE AT EL MOLINO		FACILITY NUMBER:	197607655
ADMINISTRATOR:	VIRGINIA GARCIA		FACILITY TYPE:	740
ADDRESS:	245 S. EL MOLINO AVE.		TELEPHONE:	(626) 578-0460
CITY:	PASADENA	STATE: CA	ZIP CODE:	91101
CAPACITY:	206	CENSUS:	DATE:	08/18/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Loei Lackey, Assistant Executive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not prevent resident from wandering into other residents room resulting in verbal altercations

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan 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 shortly after.

The investigation consisted of the following: LPA Margaryan obtained a copy of the staff roster, residents roster, reviewed and obtain documentation relevant to this investigation and interviewed Executive Director, Staff 1 to Staff 6 (S1 to S6) and Resident 1(R1), Resident 3 to Resident 14 ( R3 to R14). LPA was not able to interview Resident 2 (R2). R2 was at the hospital for evaluation at the time of visit.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025

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 28-AS-20250813111621

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: 08/18/2025

NARRATIVE

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Regarding allegation: Staff do not prevent resident from wandering into other residents room resulting in verbal altercations. It was alleged that R2 entered R1's room without being invited and will refuse to leave, and then R1 threatened R2 to leave while holding a fork in her hand.

Based on interviews conducted it was revealed that there are some residents that wander at the facility and R2 is one of them. R2 walks around the whole facility and goes to residents rooms sometimes if residents doors unlocked. Facility staff always encouraged residents to keep their doors closed to prevent other residents entering their rooms. Interviewed staff stated that since R2 was admitted to the facility, R2 thinks that the facility is their home and trying to enter every room and wants everyone to leave her/his house. Interviewed staff stated that they aware of R2's behavior and R2 always supervised by staff as well as others. Staff always redirect R2 when R2 is confused. On 08/13/25 R2 entered R1's room and refused to leave. Interviewed S6 stated that they heard loud voices from R1's room and rushed to R1's room. S6 saw that R1 screaming and telling R2 to leave the room. S6 stated that R1 was confused and taught that he/she was in his/her room telling R1 to leave the room. S6 redirected R2 out of R1's room. S6 stated that they didn't see that R1 holding fork in their hand. Interviewed S4 stated that was another episode of R2's behavior that R2 tried to go to room #238 and was redirected by S4. The Executive Director and staff interviewed stated that there are always enough staff to always supervise R2 and other residents and that room / residents checks are every 2 hours. Executive Director also mentioned that Police Officer from Pasadena Police Department came to the facility to do a wellness check. The Police Officer gave a case number with no report. Copy of Police case number was provided to LPA. Interviewed R1 stated that R2 entered their room uninvited and they told R2 to leave the room. R1 stated that staff is nice and helpful. Interviewed R3 stated once R2 entered his/her room and when they told R2 to leave, R2 left the room. Interviewed R12 stated that R2 sometimes enter their room when the door is not closed, but it's not bothering them. Interviewed R4, R7, R1 and R14 were unable to answer due to cognitive skills. Interviewed R5, R6, R8, R9, R10, R13, stated that they don't know R2 and no one entered their room uninvited.

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: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025

LIC9099 (FAS) - (06/04)

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