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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202402
Report Date: 01/12/2026
Date Signed: 01/12/2026 11:06:32 AM

Document Has Been Signed on 01/12/2026 11:06 AM - 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:JASMINE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
157202402
ADMINISTRATOR/
DIRECTOR:		BARCELONA, MARC OR NELIAFACILITY TYPE:
740
ADDRESS:14016 TOLUCA DRIVETELEPHONE:
(661) 829-5104
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: DATE:
01/12/2026
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:59 AM
MET WITH:Administrator Marc BarcelonaTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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On 1/12/2026 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to continued the annual inspection which originally started on 1/5/2026. LPA met with Administrator Marc Barcelona.

During the initial annual inspection on 1/5/2026 LPA found the following deficiencies which are being cited during todays visit.
  • LPA observed the fire exit from the laundry room exiting through the garage did not have an obstruction free path.
  • LPA observed scissors and a knife in an unlocked drawer in the kitchen. LPA also observed tools, paint, and other toxic solutions to be accessible in the garage.
  • LPA observed mediation and lancets in a kitchen cabinet which did not have a lock and was accessible to residents in care. Allergy medication was observed to be unlocked in a resident's.
  • LPA observed kitchen knives to be stored under the sink next to a dustpan and other cleaning items. The knives not being stored in a clean area mean the knives are not protected from contamination.
  • During file review LPA did not observe a hospice or home health care plan, and did not observe staff training for R1, R2, & R3' hospice & home health care plans.
  • During file review LPA observed R1's Magnesium Glycinate to be documented incorrectly.

Citations were issued under Title 22, deficiencies are noted on 809Ds. TSP offered and declined at this time.

Exit interview was conducted and a copy of this report LIC809, LIC809D, appeals rights were provided to Administrator Marc Barcelona.
NAME OF LICENSING PROGRAM MANAGER: Brenda Chan
NAME OF LICENSING PROGRAM ANALYST: Brianna Miranda
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2026
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 6
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 01/12/2026 11:06 AM - It Cannot Be Edited


Created By: Brianna Miranda On 01/12/2026 at 09:37 AM
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: JASMINE GARDEN RESIDENTIAL CARE
FACILITY NUMBER: 157202402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/13/2026
Section Cited
CCR
87202(a)

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87202 Fire Clearance
(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:
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Licensee will move boxes to clear obstruction and make path for exit. Licensee cleared exit in garage. LPA verified during visit on 1/12/2026.
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Based on observation & interview, th facility did not comply with the regulation listed above, which poses an Immediate health and safety risk to residents in care. Emergency exit was not free from obstruction. LPA observed various boxes obscuring the exit from the house through the garage.
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Type A
01/13/2026
Section Cited
CCR87309(a)

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87309 Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
This requirement is not met as evidenced by:
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Licensee is working on storing items properly. Currently a work in proogress. Licensee will provide verification by sending photos to the Dept.
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Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses an Immediate health and safety risk to residents in care. LPA observed a pair of scissor & knife in an unlocked kitchen drawer. LPA also observed tools, paint, and other toxic solutions unlocked and accessible in the facility’s garage.
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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.
Brenda Chan
NAME OF LICENSING PROGRAM MANAGER:
Brianna Miranda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/12/2026 11:06 AM - It Cannot Be Edited


Created By: Brianna Miranda On 01/12/2026 at 09:42 AM
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: JASMINE GARDEN RESIDENTIAL CARE
FACILITY NUMBER: 157202402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/13/2026
Section Cited
CCR
87465(h)(2)

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87465 Incidental Medical and Dental Care
(h) The following requirements shall apply to medications which are centrally stored:
(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
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Licensee will lock all medications. During today's visit LPA observed medication to be inaccessible to residents in care.
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Based on observation & interview, the facility did not comply with the regulation listed above, which poses an Immediate health and safety risk to residents in care. LPA observed medication in a unlocked cabinet in the kitchen and allergy medication in a resident’s room.
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Type A
01/13/2026
Section Cited
CCR87555(b)(15)

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87555 General Food Service Requirements
(b) The following food service requirements shall apply:
(15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination.

This requirement is not met as evidenced by:
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Licensee cleaned under the sink and removed all other clenaing items from under the sink.
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Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses an Immediate health and safety risk to residents in care. LPA observed knives to be locked and under the kitchen sink next to a hand dustpan and other cleaning items. medication in a unlocked cabinet in the kitchen and allergy medication in a resident’s room.
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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.
Brenda Chan
NAME OF LICENSING PROGRAM MANAGER:
Brianna Miranda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/12/2026 11:06 AM - It Cannot Be Edited


Created By: Brianna Miranda On 01/12/2026 at 09:50 AM
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: JASMINE GARDEN RESIDENTIAL CARE
FACILITY NUMBER: 157202402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2026
Section Cited
CCR
87633(4)

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87633 Hospice Care of Terminally Ill Residents
(4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident’s hospice agency and agreed to by the licensee and the resident, or prospective resident, or the resident’s or prospective resident’s Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s).

This requirement is not met as evidenced by:
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During today's visit Licensee provided copy of of care plans for R1, R2, & R3.
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Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. LPA reviewed R1 & R2 records and did not find a hospice care plan. Administrator stated they did not have a hospice plan.
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Type B
01/26/2026
Section Cited
CCR87633(6)

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87633 Hospice Care of Terminally Ill Residents
(6) Identification of the training needed, which staff members need this training, and who will provide the training relating to the licensee’s responsibilities for implementation of the hospice care plan.

This requirement is not met as evidenced by:
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Licensee will provided copies of staff training for care plans and hospice care plans by POC due date.
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Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. LPA reviewed R1 & R2 records and did not find verification of staff training for resident's hospice care plan. Administrator stated they did not have a hospice plan on file.
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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.
Brenda Chan
NAME OF LICENSING PROGRAM MANAGER:
Brianna Miranda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2026


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 01/12/2026 11:06 AM - It Cannot Be Edited


Created By: Brianna Miranda On 01/12/2026 at 09:54 AM
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: JASMINE GARDEN RESIDENTIAL CARE
FACILITY NUMBER: 157202402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2026
Section Cited
CCR
87465(6)

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87465 Incidental Medical and Dental Care
(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.
This requirement is not met as evidenced by:
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Licensee will review all centrally stored logs and verify accurace. Licensee will provide a statement to the Dept regarding correcting Centrally stored medication log.
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Based on observation, interview, and record, facility did not comply with the regulations listed above, which poses a potential health and safety risk to residents in care. LPA reviewed centrally stored medication log which for R1 which did not have matching information from the dose on the bottle, MARS, and centrally stored.
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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.
Brenda Chan
NAME OF LICENSING PROGRAM MANAGER:
Brianna Miranda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2026


LIC809 (FAS) - (06/04)
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