Jasmine Garden Residential Care

Type of visit: Case Management - Annual Continuation

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.the state’s words, verbatim · CDSS document, Jan 12, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jan 13, 2026

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: 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.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: 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.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Jan 13, 2026

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: 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.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: Licensee is working on storing items properly. Currently a work in proogress. Licensee will provide verification by sending photos to the Dept.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jan 13, 2026

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: 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.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: Licensee will lock all medications. During today's visit LPA observed medication to be inaccessible to residents in care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87555(b)(15) · Plan of correction due date: Jan 13, 2026

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: 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.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: Licensee cleaned under the sink and removed all other clenaing items from under the sink.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(4) · Plan of correction due date: Jan 26, 2026

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: 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.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: During today's visit Licensee provided copy of of care plans for R1, R2, & R3.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87633(6) · Plan of correction due date: Jan 26, 2026

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: 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.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: Licensee will provided copies of staff training for care plans and hospice care plans by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(6) · Plan of correction due date: Jan 26, 2026

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: 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.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: Licensee will review all centrally stored logs and verify accurace. Licensee will provide a statement to the Dept regarding correcting Centrally stored medication log.

Type of visit: Required - 1 Year

On 1/5/2026 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct an annual inspection. LPA was greeted by Administrator Marc Barcelona, and allowed entrance into the facility. Facility is licensed for 6 residents and has a current census of 4. LPA observed the residents to each have their own room. The resident rooms are properly furnished with adequate lighting. Smoke and carbon monoxide detectors were tested and are in working conditions. Common bathroom water temperature read at 112.9. Fire extinguishers were last serviced on 7/18/2025 and still have charge. Due to time constraints LPA will return at a later date to review deficiencies with Administrator. Citations will be issued upon follow-up visit. Exit interview conducted and a copy of this report LIC809 was provided to Administrator Marc Barcelona.the state’s words, verbatim · CDSS document, Jan 5, 2026

Type of visit: Required - 1 Year

On 11/20/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. Administrator, Marc Barcelona, is not able to attend this inspection. LPA met with assistant Administrator, Myat Tusaw. LPA reviewed facility records and found the following: Upon review of resident records, LPA found that 3 out of 4 residents did not have a needs and services/care plan on file. Facility did not have records available to review for 2 out of 2 staff on duty. LPA did not observe initial/annual training in the employee training file for 2 out of 2 staff on duty. Emergency disaster plan was not updated. Last documented fire drill was conducted on 01/22/2024. Medications reviewed. LPA found multiple medications not stored in their original container and stored in zip-lock bags. LPA observed multiple over-the-counter medications being administered to residents in care, facility did not have a prescription or documentation showing the medication was authorized by a physician. Fire extinguisher was last serviced on 03/26/2024. LPA conducted a facility tour with Assistant Administrator. Common areas were observed to be furnishing and had adequate lighting. LPA toured resident bedrooms. Bedrooms observed to have required furnishings. LPA toured facility bathrooms. Hot water measured at 99.3 degrees F. LPA observed a bottle of Clorox disinfectant wipes accessible to residents in care under the bathroom sink. Kitchen toured. LPA observed an adequate food supply. LPA observed the cabinet under the kitchen sink to be unlocked. The cabinet stores cleaning supplies including Ajax that were accessible to residents in care. LPA observed the medication cabinet to be unlocked and accessible to persons other than facility staff. LPA observed an adequate supply of linens. Exterior tour conducted. Exits were open and free from obstructions during today's inspection. CONTINUED TO 809C Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. During the annual inspection on 12/18/2023, the facility received deficiencies for California Code of Regulations sections 87303 and 87309. Civil penalties in the amount of $500 is being assessed for repeat violations of sections 87303(e)(2) and 87309(a). Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to Assistant Administrator, Myat Tusaw, whose signature on this form confirms receipt of these documents. LPA discussed the Technical Support Program (TSP) with the facility representative. LPA offered to refer the facility to TSP. Facility representative accepted the offer on behalf of the Administrator. LPA is requesting the following documents be submitted to the Fresno CCL office by 12/04/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond*the state’s words, verbatim · CDSS document, Nov 20, 2024

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: POC

On 01/24/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a POC visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Marc Barcelona. The purpose of this visit is to measure the water temperature in the resident bathroom to ensure the hot water is between 105-120 degrees F. per section 87303(e)(2). LPA measured the hot water in resident bathroom, hot water measured at 111.0 degrees F. POC is cleared during today's visit. No deficiencies issued during today's visit. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Marc Barcelona, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Jan 24, 2024

Type of visit: Required - 1 Year

On 12/18/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff granted LPA entry to the facility and contact the Administrator via telephone. Administrator, Marc Barcelona, arrived a short time later. LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. LPA observed that the tub faucet was leaking, facility placed a large bucket under the faucet. Hot water measured at 122.7 degrees F. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable and 2-day supply of perishable food. LPA observed Clorox wipes accessible to residents in care and the stove knobs were not removed when the stove was not in operation. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching. Fire extinguisher serviced on 03/20/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted on 10/25/2023. LPA reviewed staff and client records. Medications reviewed and observed to have original labels and be administered as prescribed. Medications were observed to be accessible to residents in care due to the lock on the cabinet needing to be repaired. LPA observed multiple pills/tablets in a zip lock bag in the medication cabinet as well as 3 prescription bottles that contained discontinued medication. Administrator stated that medications are in the cabinet due to needing to be destroyed. Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Marc Barcelona, whose signature on this form confirms receipt of this document. LPA is requesting the following documents be submitted to the Fresno CCL office by 01/08/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond*the state’s words, verbatim · CDSS document, Dec 18, 2023

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.