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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208887
Report Date: 02/02/2026
Date Signed: 02/02/2026 12:45:46 PM

Document Has Been Signed on 02/02/2026 12:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:FIVE STAR ASSISTED LIVING CORPFACILITY NUMBER:
107208887
ADMINISTRATOR/
DIRECTOR:		OGANYAN, HASMIK JASMINEFACILITY TYPE:
740
ADDRESS:2573 W. BARSTOW AVETELEPHONE:
(559) 283-8543
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: DATE:
02/02/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:56 AM
MET WITH:Licensee, Jasmin OganyanTIME VISIT/
INSPECTION COMPLETED:
12:54 PM
NARRATIVE
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On 02/02/2026 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced case visit. LPA met by Direct Care Staff, Esther and Henry Alsisto explained reason for visit and was permitted entry into the facility. Licensee/Administrator, Jasmine Oganyan was contacted and arrived some time later. A tour of the facility was completed. A health and safety check was completed on residents in care. Residents were observed in common area and in rooms. There are currently 6 residents present during todays visit. 1 of 6 is bedridden and 3 of 6 are receiving hospice services at this time.

This case management visit is being conducted as follow up to complaint investigation for complaint #24-AS-20260126163939. During review of records for this complaint it was observed that the Licensee is not reporting incidents to the Department as required. Interviews conducted during complaint disclosed R1 passed on 07/28/2025. LPA reviewed incident reports for R1’s death. Death reports were not submitted by the Licensee from the period of 3/25/25 through 2/2/26. During interviews with Licensee and their spouse LPA observed them looking for copies of the death reports and fax confirmations however, they were unable to be located. Incident reports are not being submitted to the Department as required by Title 22. Deficiencies cited per California Code of Regulations, Title 22. If not corrected, deficiencies will pose a direct impact to residents in care.

Exit interview completed with Licensee, Jasmine. A copy of this report, deficiencies and appeal rights provided.
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mary Garza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 02/02/2026 12:45 PM - It Cannot Be Edited


Created By: Mary Garza On 02/02/2026 at 12:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: FIVE STAR ASSISTED LIVING CORP
FACILITY NUMBER: 107208887

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2026
Section Cited
CCR
87211(1)

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87211 Reporting Requirements (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case…
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Licensee stated they are currently providing reports to the Department via efax and they must not be going through. Licensee stated they will have to review their reporting by efax and come up with another method. Licensee stated they will provide all incident reports in person. Licensee stated they will contact customer service for the efax and provide a copy of the service order/receipt as proof of correction by POC date.
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This requirement was not met as evidence by: records reviewed, the licensee did not comply with the section cited above in that review of incident reports provided to the Department are not being completed. LPA reviewed incident reports for R1’s death. Death reports were not submitted by the Licensee from the period of 3/25/25 through 2/2/26. R1 passed on 7/28/25. This poses a potential health safety and or personal rights risk to residents in care.
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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.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Mary Garza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2026


LIC809 (FAS) - (06/04)
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