197607655-1-9-2026-28-AS-FFIS-DQQ3G3-20260126171338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607655
Report Date: 01/09/2026
Date Signed: 01/09/2026 01:26:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
09/24/2025 and conducted by Evaluator Luis DeLeon

COMPLAINT CONTROL NUMBER: 28-AS-20250924204158

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: 139	DATE:	01/09/2026
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Assistant Administrator Lori Lackey		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff does not provide adequate supervision resulting in resident falling.
Staff did not seek medical attention to resident.

INVESTIGATION FINDINGS:

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On today’s visit, Licensing Program Analyst (LPA) Luis De Leon conducted a subsequent complaint visit and met with Assistant Administrator Lori Lackey. LPA explained the reason for today’s visit was to deliver findings on the above allegations. LPA toured the physical plant and observed residents’ common areas engaging in various activities and observed no health and safety risks to residents in care. LPA obtained staff and resident rosters, incidents reports, and interviewed two residents.

During the initial visit on 10/02/2025, LPAs toured the facility and obtained copies of the following documents: Staff roster, Resident roster, R1’s physicians reports, R1’s resident assessments, R1’s admission agreement, R1’s face sheet, nurses notes, incidents reports. LPA interviewed eleven (10) residents and seven (7) staff.

Report continues on page LIC-9099c

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026

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 28-AS-20250924204158

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JASMIN TERRACE AT EL MOLINO	FACILITY NUMBER: 197607655
	VISIT DATE: 01/09/2026

NARRATIVE

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Regarding allegation: Staff does not provide adequate supervision resulting in resident falling

It is alleged that Staff does not provide adequate supervision resulting in resident falling. It is alleged that R1 has experienced falls while living at the facility due to lack of care and supervision. On 8/30/2025, R1 fell forward from edge of bed. Resident evaluation was performed, and resident was able to move all extremities without pain. On 8/31/2025, R1’s doctor’s nurse practitioner examined R1 on a video call and determined that there was no need for hospital visit. On 9/22/2025, R1 experienced another fall while transferring from recliner with staff assistance. R1 was transported to hospital. Investigation consisted of interviews with staff, residents, and review of R1 facility file. LPA was unable to interview R1 since R1 was in hospital during initial visit, and on today’s visit, R1 is no longer residing at facility. During interview with the residents, three (3) out of fifteen (15) residents experienced a fall at the facility. R7 stated that R7 did not need assistance after fall, R15 did not recall details of fall, and R14 stated that R14 lost balance. Twelve (12) out of fifteen (15) residents stated that residents don’t need supervision or were not able to respond whether residents needed supervision. R1, R7, R9, and R14 stated that staff take good care and supervise residents. During record’s review, R1’s physician’s report and R1’s appraisal reports, it revealed that R1 is non-ambulatory and has no history of fall. During interview with staff, eight (8) out of eight (8) staff denied the above allegations. S1 stated that the facility has twelve (12) caregivers, two (2) med-techs, and two (2) supervisors in the morning and afternoon shifts. The facility has a policy of a wellness check every 2 hours. S4 and S5 stated that there is enough staff to provide supervision for residents. Staff stated that facility protocol is to always evaluate residents after sustaining a fall and transport residents to hospital for evaluation if necessary. Based upon the investigation, client and staff interviews, document review, and LPA observations, the facility provides adequate supervision to residents in care.

Report continues on page LIC-9099c...

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250924204158

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JASMIN TERRACE AT EL MOLINO	FACILITY NUMBER: 197607655
	VISIT DATE: 01/09/2026

NARRATIVE

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Regarding allegation: Staff did not seek medical attention to resident.
It is alleged that facility staff did not seek medical attention in a timely manner for R1. On 8/30/2025 and 9/22/2025, R1 suffered falls where it is alleged that no medical attention was provided. Investigation consisted of interviews with staff, residents, and review of R1 facility file including incident reports, doctor’s communication, and nurse notes for R1’s incidents. The investigation reveals the following: The facility staff sought medical assistance for R1’s falls. On R1’s fall on 8/30/2025, facility staff performed R1’s evaluation after the fall and facility staff determined that R1 was able to move all extremities without pain or discomfort. On 8/31/2025, the facility sought medical support to R1’s doctor office and nurse practitioner determined to apply antibiotic cream to red nose. The nurse practitioner determined that no other medical assistance was needed. R1’s responsible party was notified, and responsible party refused emergency room transport. On 9/22/2025, R1 experienced another fall while transferring from recliner with staff assistance. R1 sustained a bump on left side of head. R1 was transported to hospital for further evaluation. During interviews with the residents, nine (9) out of fifteen (15) residents stated that staff is supportive of residents’ medical needs including setting up appointments, going to doctor, or hospital. Residents stated that residents were confident that staff would assist with their medical needs if requested. Interview with staff revealed that eight (8) out of eight (8) staff denied knowledge of the above allegation. Staff stated that staff follow protocol for resident’s falls to seek medical attention after a resident fall. Staff denied ever refusing to seek medical attention for any resident in care. Staff stated that, per protocol, staff follows contact information with residents’ physicians and residents’ responsible party. Based upon the investigation, client and staff interviews, document review, and LPA observations, the facility staff provided first aid and sought medical attention to R1's physician after both fall incidents. R1’s physician and responsible party were notified after each fall.

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.

Exit interview held with Executive Director Virginia Garcia. A copy of the report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026

LIC9099 (FAS) - (06/04)

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