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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206768
Report Date: 03/07/2026
Date Signed: 03/07/2026 06:10:56 PM

Document Has Been Signed on 03/07/2026 06:10 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:JASMINE GARDEN RESIDENTIAL CARE IIFACILITY NUMBER:
157206768
ADMINISTRATOR/
DIRECTOR:		BARCELONA, NELIAFACILITY TYPE:
740
ADDRESS:14012 TOLUCA DRIVETELEPHONE:
(661) 428-1634
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 4DATE:
03/07/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:04 PM
MET WITH:Administrator Nelia BarcelonaTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
NARRATIVE
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On March 7, 2026 Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with Administrator Nelia Barcelona.

Facility is licensed for 6 residents and has a current census of 4. There is 1 resident on hospice and 2 with a health care plans. Water temperature was checked in the kitchen which read at 135.1 degrees Fahrenheit and the common bathroom which read at 131.9 degrees Fahrenheit. Fire Extinguisher was serviced September 3, 2025 and is within the safety regulation period. Smoke and carbon monoxide detectors were tested. Carbon monoxide detector is in working ordered. One out of four of the smoke detectors are working properly. Emergency exits are clear and free from obstruction. In the garage LPA observed laundry detergent, cans of paint, drill, and box cutter to be accessible to the residents.
LPA observed medication in cabinets which were not locked and accessible to resident in care. Medication refills were observed on a shelf to the left of the refrigerator, which were not locked and accessible to residents in care. LPA observed knives and sharps to be under the kitchen sink with key left in the lock which makes the knives accessible to residents in care. While touring the facility staff locked the cabinet under the sink, but left the key in the lock. LPA observed the sink having debris and cleaning sponge.

Nelia’s Administrator's Certification expires January 24, 2027. Staff files were reviewed, are complete, and current. Resident files were reviewed, complete, and current. Facility provided a log for disaster drills that are conducted quarterly. First aid kit on site. LPA observed some toxins and cleaning supplies to be in an unlocked cabinet in the laundry room.
NAME OF LICENSING PROGRAM MANAGER: Brenda Chan
NAME OF LICENSING PROGRAM ANALYST: Brianna Miranda
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2026
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 03/07/2026 06:10 PM - It Cannot Be Edited


Created By: Brianna Miranda On 03/07/2026 at 03:43 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: JASMINE GARDEN RESIDENTIAL CARE II
FACILITY NUMBER: 157206768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

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 which poses an immediate health, safety or personal rights risk to persons in care. LPA observed water temperature in kitchen 135.1 degrees Fahrenheit & common bathroom 131.9 degrees Fahrenheit.
POC Due Date: 03/09/2026
Plan of Correction
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Licensee will adjust water heater and send video verification to the Dept of water temperature being corrected. Verification will be sent to the Dept by POC date.
Type A
Section Cited
CCR
87309(a)
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:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Cabinet under the sink was unlocked with key left in lock, cleaning solutions & disinfectants were left in unlocked cabinet. These items were accessible to residents.
POC Due Date: 03/09/2026
Plan of Correction
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Licensee locked the cabinets while LPA was still in the facility. POC was cleared today March 3, 2026 while LPA was in the facility.
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: 03/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2026


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 03/07/2026 06:10 PM - It Cannot Be Edited


Created By: Brianna Miranda On 03/07/2026 at 03:43 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: JASMINE GARDEN RESIDENTIAL CARE II
FACILITY NUMBER: 157206768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(f)
Storage Space and Access
(f) Due to the physical arrangements in the facility, or the condition or the habits of other residents in the facility, or both, the licensee may require the items specified in subsections (a) and (c) to be centrally stored so as not to pose a safety hazard to others.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & record review, the licensee did not comply with the section cited which poses an immediate health, safety or personal rights risk to persons in care. R1 & R3 are at risk for personal hygiene items being accessible. LPA observed hygiene products accessible in R1 & R3's bedrooms, in common bathroom, and in R2's bathroom.
POC Due Date: 03/09/2026
Plan of Correction
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Licensee will collect all hygiene products and store in an inaccessible storage. Picture verification will be sent to the Dept by POC due date.
Type A
Section Cited
CCR
87465(a)(6)
Incidental Medical and Dental Care Services
(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:
Deficient Practice Statement
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Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. R2 MAR shows PM medication Trazadone 50 mg was given, when it is supposed to be given at bed time. R1’s medication Quetiapine Fumarate 25 MG was not logged on the Centrally Stored Medication Log.
POC Due Date: 03/09/2026
Plan of Correction
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Licensee will correct centrally stored medication log for R1 and any other resident's. Verification will be sent to the Dept by the POC due date.
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: 03/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2026


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 03/07/2026 06:10 PM - It Cannot Be Edited


Created By: Brianna Miranda On 03/07/2026 at 03:43 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: JASMINE GARDEN RESIDENTIAL CARE II
FACILITY NUMBER: 157206768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(2)
Incidental Medical and Dental Care Services
(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:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed medication cabinets were not locked and key was left in lock of the cabinet. Medication refills were left on a cabinet left of the refrigerator.
POC Due Date: 03/09/2026
Plan of Correction
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Licensee locked the cabinets while LPA was still in the facility. POC was cleared today March 3, 2026 while LPA was in the facility.
Type A
Section Cited
CCR
87608(a)(5)(B)
Postural Supports
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/09/2026
Plan of Correction
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Full bed rails will be removed or a doctors order for full bed rails will be obtained. Verification of either will be sent to the Dept by POC due date.
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: 03/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2026


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 03/07/2026 06:10 PM - It Cannot Be Edited


Created By: Brianna Miranda On 03/07/2026 at 03:43 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: JASMINE GARDEN RESIDENTIAL CARE II
FACILITY NUMBER: 157206768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87202(a)
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:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed 3 of the 4 smoke detectors tested not fully functioning.
POC Due Date: 03/13/2026
Plan of Correction
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Licensee replaced batteries and smoke detectors are in working order. POC was cleared today March 3, 2026 while LPA was in the facility.
Type B
Section Cited
CCR
87308(c)
Resident and Support Services
(c) General storage space shall be maintained for equipment and supplies as necessary to ensure that space used to meet other requirements of these regulations is not also used for storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee stated additional blankets for the facility are being stores in R2's master bedroom.
POC Due Date: 03/13/2026
Plan of Correction
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Licensee will removed items that do not belong to R3 & R4. Pictures to verification will be sent to the Dept by POC due date.
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: 03/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2026


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 03/07/2026 06:10 PM - It Cannot Be Edited


Created By: Brianna Miranda On 03/07/2026 at 03:43 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: JASMINE GARDEN RESIDENTIAL CARE II
FACILITY NUMBER: 157206768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87633(b)
(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA did not observe a current hospice care plan for R3 on file.
POC Due Date: 03/13/2026
Plan of Correction
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Licensee will get the current plan for R3 and provide to the Dept by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Brenda Chan
NAME OF LICENSING PROGRAM MANAGER:
Brianna Miranda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2026


LIC809 (FAS) - (06/04)
Page: 7 of 8
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: JASMINE GARDEN RESIDENTIAL CARE II
FACILITY NUMBER: 157206768
VISIT DATE: 03/07/2026
NARRATIVE
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LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms, bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean, properly furnished, with adequate lighting, and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable.
The following deficiencies were cited:
  • Water temperature in kitchen 135.1 degrees Fahrenheit & common bathroom 131.9 degrees Fahrenheit Cabinet under the sink was unlocked with key left in lock, scissor in unlocked kitchen drawer.
  • Cleaning solutions & disinfectants were left in unlocked cabinet. These items were accessible to residents.
  • R1, & R3 are at risk for personal hygiene items being accessible. LPA observed hygiene products accessible in R1 & R3's bedrooms, in common and bathroom.
  • R1 MAR shows PM medication Trazadone 50 mg was given, when it is supposed to be given at bed time. R1’s medication Quetiapine Fumarate 25 MG was not logged on the Centrally Stored Medication Log.
  • Medication cabinets were not locked and key was left in lock of the cabinet. Medication refills were left on a shelf left of the refrigerator.
  • R3’s hospice care plan did not indicate full bed rails were to be used.
  • 3 of the 4 smoke detectors tested not fully functioning.
  • Additional blankets for the facility are being stored in R2's master bedroom closet.
  • Debris and cleaning sponges were found under the kitchen sink where the kitchen knives are stored.
  • R3 did not have a current hospice care plan on file (December 25, 2025- February 22, 2026).

Deficiencies observed were cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted and a copy of this report LIC809, LIC809D, and appeal rights will be provided via email on March 7, 2026 to Administrator Nelia Barcelona.
NAME OF LICENSING PROGRAM MANAGER: Brenda Chan
NAME OF LICENSING PROGRAM ANALYST: Brianna Miranda
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2026
LIC809 (FAS) - (06/04)
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