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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209370
Report Date: 09/30/2025
Date Signed: 09/30/2025 05:19:51 PM

Document Has Been Signed on 09/30/2025 05:19 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:CHATEAU JESADEANFACILITY NUMBER:
107209370
ADMINISTRATOR/
DIRECTOR:		ROYCHOUDHURY, MINAKSHIFACILITY TYPE:
740
ADDRESS:5633 N MAROA AVENUETELEPHONE:
(559) 499-8229
CITY:FRESNOSTATE: CAZIP CODE:
93704
CAPACITY: 6CENSUS: 5DATE:
09/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH: Licensee Minakshi Roychoudhury via telephone and Administrator Shailesh "Steve" PatelTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On 09/30/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct required Annual visit. LPA introduced self, stated the purpose of the visit, and was greeted by staff Angel Hocog. Four residents were present during inspection. Licensee (L1) Minakshi Roychoudhury and Administrator (A1) Shailesh "Steve" Patel was called. LPA spoke with L1 via telephone until A1 arrived. A1 arrived shortly during inspection. LPA toured facility with A1. One resident left during inspection.

The facility is a 6 Bedroom and 3 Bathroom home with a fire clearance granted for 6 residents of all residents may be Non-Ambulatory.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. At approximately 08:58AM, LPA observed S1 removing knives from unlocked dishwasher to locked kitchen shelf over the stove. LPA observed S1 operating dishwasher during visit. At approximately 09:07AM, LPA and S1 observed a medication bottle unlock in the kitchen drawer. Medications observed kept locked in medication cabinet. Medications were checked, Centrally stored medications list and MARs were reviewed. Fire extinguisher was observed in the kitchen cabinet with last serviced date of 09/11/25. L1 stated last fire drill completed on 02/2025. An adequate supply of perishable and non-perishable food was observed. Expired perishable foods were observed. Refrigerator temperature maintained at 40 degrees F and freezer temperature at 0 degrees F. Chemicals observed locked in laundry shelf and under kitchen sink. A hole was observed on the wall in the parlor room.

Lic 809 continues.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 15
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)
Page: 2 of 15
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: CHATEAU JESADEAN
FACILITY NUMBER: 107209370
VISIT DATE: 09/30/2025
NARRATIVE
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All bedrooms were observed to have the required furnishings and adequate lighting. Hot water temperature was tested at 114.9 degrees F in bathroom 1, 110.1 degrees F in master bathroom, and 103.9 degrees F in bathroom 2. Toilet observed functional. At approximately 10:35AM, LPA and A1 observed a chemical bottle unlock on the bathroom 1 on the bathroom tub. Mold was observed under bathroom sink in the master bedroom. Extra linens and towels were observed in hall closet and laundry room. At approximately 10:49AM, LPA and A1 observed facility exit 5 in room 5 blocked by a metal lever on the bottom the sliding door. Wall outlet was observed disrepair in room 5 and room 6. Bedridden resident was observed lying in bed with half rails in room 6. Washer and dryer observed functional and operational during inspection. Chemicals were observed stored and unlocked in garage cabinet. A gardening tool was observed stored unlocked in garage shelf.

Outside of the facility toured and observed to be free of debris. The side gate observed clear of obstruction. Adequate outdoor seating observed for clients. All residents and staff files reviewed. Smoke detectors observed operational during inspection. Carbon monoxide was observed not operational during inspection.

A deficiency and an immediate Civil Penalty were assessed. See Lic 421IM is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6 see attached 809D.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 10/06/25. Forms requested: Lic 308, Lic 500, Lic 610E, Lic 9020, current administrator certificate, and current liability insurance. A copy of this report and appeal rights was provided to Administrator, whose signature on this form confirms receipt of this report.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Mai Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC809 (FAS) - (06/04)
Page: 3 of 15
Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:16 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1569.311
HSC 1569.311 Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when carbon monoxide was not operating during visit, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2025
Plan of Correction
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2
3
4
Administrator will ensure there is a operating carbon monoxide by POC due date. Proof will be sent to Fresno CCL by POC due date 10/01/25.
Type A
Section Cited
CCR
87309(a)
87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA observed 08:58AM, S1 removing knives from the dishwasher and locking it in shelf over the stove. LPA and A1 observed cleaning chemicals unlock on bathroom 1 tub and in the garage. A gardening tool was observed in the shelf in the garage unlock. accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2025
Plan of Correction
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Administrator immediately removed the chemicals and lock in laundry room shelves. POC cleared during visit.
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 4 of 15
Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:17 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87555(b)(8)
87555(b)(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state, and local authorities. Good in damaged containers shall not be accepted, used, or retained.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation, expired perishable foods were observed, poses/posed an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2025
Plan of Correction
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Administrator immediately disregarded expired food. POC cleared during visit.
Type A
Section Cited
HSC
1569.618(c)(3)
HSC 1569.618 (c)(3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.

This requirement is not met as evidenced by:
Deficient Practice Statement
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All staff files were reviewed, A1, S2, and S3 did not have current First Aid/ CPR certification on file, this poses an immediately health and safety risk for the residents in care.
POC Due Date: 10/01/2025
Plan of Correction
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Licensee shall ensure that staff have current First Aid and CPR certification. Proof of A1, S2, and S3 First Aid/ CPR certification is to be submitted to the Fresno CCL by 10/01/25.
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 5 of 15
Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:19 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(2)
87465(h)(2) Centrally stored medicines shall be kept in a safe and locked place... not accessible to persons other than employees...

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA and S1 observed medication Vitamin C bottle stored in the kitchen drawer next to the stove unlock, which poses an immediate health, safety or personal rights risk to person in care.
POC Due Date: 10/01/2025
Plan of Correction
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Staff immediately removed medication into locked medication shelf. POC cleared during visit.
Type A
Section Cited
CCR
87202(a)
87202 (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA and A1 observed facility exit 5 in room 5 blocked with a metal leaver rod preventing sliding exit door to open, which an immediate health and safety risk which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2025
Plan of Correction
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Administrator immediately removed metal lever rod. POC cleared during visit.
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:22 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87606(c)
87606 (c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interviews conducted, the licensee did not comply with the section cited above, the facility has no fire clearance for bedridden and has R1 a bedridden resident whose not receiving hospice care reside in room 1, which an immediate health and safety risk which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2025
Plan of Correction
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2
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Licensee shall obtain a fire clearance request for bedridden or submit a plan on relocation of R1 to Fresno CCL by POC due date 10/01/25.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 7 of 15
Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:29 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87612(a)(2)
87612 (a)(2) The licensee may provide care for residents who have any of the following restricted health conditions,(2) Catheter care as specified in Section 87623.

This requirement is not met as evidenced by
Deficient Practice Statement
1
2
3
4
Based on interview conducted, observation, and records reviewed, R1 has a restricted health conditions with no restricted health condition care plan on file or in placed, poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 10/10/2025
Plan of Correction
1
2
3
4
Administrator will submit a Restricted Health Condition care plan for R1 to the Fresno CCL by POC due date 10/10/25.
Type B
Section Cited
CCR
87463(b)
87463(b) The reappraisal shall document significant changes in the resident’s physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in section 87466, Observation of the Resident.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview conducted, observation, and records reviewed, R1 was admitted to the facility as nonambulatory status and have become bedridden, and no reappraisal was completed for change of condition, poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 10/06/2025
Plan of Correction
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2
3
4
R1 reappraisal will be completed and submitted to the Fresno CCL by POC due date 10/06/25.
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:30 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(a)(3)
87608 (a)(3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview conducted, observation, and records reviewed, R1 was observed laying in hospital bed with ½ rails on each side. There is no doctor’s order for ½ rail bed for R1, which poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 10/03/2025
Plan of Correction
1
2
3
4
Administrator will obtain doctor orders for R1 indicating the need for half bed rail if physician indicates the need for half bed rail or Half rails will be removed by POC due date 10/3/25.
Type B
Section Cited
CCR
87211(a)(1)
87211(a)(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.

This requirement was not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview conducted, Licensee did not submit a written report to the department within 7 days of incident when R1 had went to the hospital on 07/08/25, 09/19/25, 09/20/25 and when R2 went to the hospital on 09/12/25, this poses a potential health and safety risk to residents in care.
POC Due Date: 10/06/2025
Plan of Correction
1
2
3
4
Licensee will submit review Reporting Requirements regulation, and a plan detailing steps the facility will take to ensure the requirements of Reporting requirements are met by the POC due date 10/06/25.
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 9 of 15
Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:32 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.695(c)
HSC 1569.695(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in the drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interviews conducted with Licensee, last emergency disaster drill was completed on 02/2025 and not recorded, which poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 10/06/2025
Plan of Correction
1
2
3
4
Licensee shall ensure emergency disaster drills are completed quarterly and documented. Emergency drill is to be completed and submitted to the Fresno CCL by POC due date 10/06/25.
Type B
Section Cited
CCR
87303(a)(1)
87303(a)(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.

This requirement was not met as evidenced by:

Deficient Practice Statement
1
2
3
4
Based on observation, mold was observed under bathroom sink in room 1 bathroom, which poses a potential Health, Safety, and Personal Rights risk to the resident.

POC Due Date: 10/10/2025
Plan of Correction
1
2
3
4
Licensee shall ensure there is no molding in resident’s bathroom by deep cleaning or replacing bathroom sink. Proof shall be submitted to Fresno CCL office by POC due date 10/17/25.
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 10 of 15
Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:33 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)
87412(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4

Based on record review and interview, the licensee did not comply with the section cited above when A1’s personnel file was not observed maintained at the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 10/03/2025
Plan of Correction
1
2
3
4
Licensee will submit a written statement detailing the steps the facility will take to ensure the requirements for section 87412 are met to the Fresno CCL office by POC due date 10/03/25.
Type B
Section Cited
CCR
87412(c)(2)
87412 (c)(2) Documentation of staff training

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, the licensee did not comply with the section cited above when all staff files did not have the proper documentation of staff trainings, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/03/2025
Plan of Correction
1
2
3
4
Licensee will submit a written statement detailing the steps the facility will take to ensure all staff training have the proper documentation including trainer’s full name, subject covered in the training, date of the training, number of hours of training per subject. Written statement will be submitted the Fresno CCL office by POC due date 10/03/25.
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 11 of 15
Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:35 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(F)
87411(F) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties.

This requirement is not met as evidenced by:

Deficient Practice Statement
1
2
3
4
Based on records review, S2 did not have a TB result and good health screening on file. S3 did not have good health screening on file, which poses a potential risk to the health and safety of the residents.
POC Due Date: 10/17/2025
Plan of Correction
1
2
3
4
S2 and S3 TB results with S3 good health screening shall be submitted to the Fresno CCL office by POC due date 10/17/25.

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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 12 of 15
Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:36 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(c)(3)
87465 (c)(3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interviews and records reviewed, R2’s medication Lactulose 10gm/15 ml, PRN medication Acetaminophen 325mg, and PRN medication Hydroxyzine HCL 50 mg were not record in the resident’s MAR , which poses a potential health and safety risk for the person in care.
POC Due Date: 10/01/2025
Plan of Correction
1
2
3
4
Administrator record all R2’s medications into the resident’s MARs during visit. POC cleared during visit.
Type B
Section Cited
CCR
87465(h)(6)
87465 (h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview conducted, observation, and records reviewed, R2’s current medication Lactulose 10gm/15 ml, PRN medication Acetaminophen 325mg, PRN medication Hydroxyzine HCL 50 mg, medication Rifampin were not record in Centrally Stored Medication (Lic 622) record, poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 10/01/2025
Plan of Correction
1
2
3
4
Administrator recorded all R2’s medication into centrally stored medication list during visit. POC cleared during visit.
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 13 of 15
Document Has Been Signed on 09/30/2025 05:19 PM - It Cannot Be Edited


Created By: Mai Yang On 09/30/2025 at 03:38 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: CHATEAU JESADEAN
FACILITY NUMBER: 107209370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
87303 (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:

Deficient Practice Statement
1
2
3
4
Based on observation, a hole was observed in the parlor room on the wall, wall was observed in disrepair in room 2, wall electric outlet was in disrepair in room 5 and in room 6. Electric wall outlet in dining room rock wall not working, poses/posed a potential health and safety and personal rights risk to the resident in care.
POC Due Date: 10/20/2025
Plan of Correction
1
2
3
4
Hole on the wall and wall outlets are to be in good repair by POC due date. Proof of repair will be submitted to the Fresno CCL by POC due date 10/20/25.
Type B
Section Cited
CCR
87609(b)(4)
87609 (b)(4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview conducted, the licensee did not comply with the section cited above when LPA review R2’s and R3’s file, whose currently receiving home health with no home health care plan on file, which poses a potential health or personal rights risk to persons in care.
POC Due Date: 10/06/2025
Plan of Correction
1
2
3
4
Administrator will obtain R1 and R3’s home health record and submit it to Fresno CCL by POC due date 10/06/25.
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:
Mai Yang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 14 of 15