Jasmine Garden Residential Care II

Type of visit: Required - 1 Year

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. 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.the state’s words, verbatim · CDSS document, Mar 7, 2026

Type of visit: Required - 1 Year

On 1/31/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced himself, stated the purpose of the visit, and was greet by Staff (S1) Sun Sun Wai, LPA was granted entry. 4 residents were present during inspection. Administrator (A1) Marc Barcelona arrived shortly after LPA’s arrival. LPA toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. A sample of resident’s medications were checked and observed kept locked in medication cabinet. Lisinopril 20 mg 1 tab by mouth taken twice daily, the label says once daily and MARS and Centrally Stored Medication Record says medication should be taken twice daily. Clients’ MARS was reviewed. D3 1000 1 tab taken by mouth once daily has not been signed off since 1/19/25. Fire extinguisher reviewed with a service date of: 3/26/24. Fire drill last completed on 1/7/25. Clients' bedrooms were toured and reviewed. Cleaning chemicals was observed stored and locked in facility cabinet. Resident's rooms were observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a range of 112.6 to 115.7 degrees F in 2 bathrooms. Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained range at 40 degrees F. Carbon monoxide were tested and observed to be operational. All clients’ files reviewed to have all the required documents. All staff files were reviewed to have all required documents. 1 deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 2/14/25: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance-RCFE, Emergency and Disaster Plan (LIC 610E -RCFE), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A- RCFE) A copy of this report and appeal rights was provided to A1, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jan 31, 2025

Type of visit: Required - 1 Year

On 03/11/2024, 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. LPA met with Administrator, Nelia Barcelona. LPA conducted a tour inside and outside of facility. Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. Hot water measured at 109.7 degrees F. Kitchen toured. Kitchen appeared clean, LPA observed an adequate food supply. 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 1/22/2024. LPA reviewed staff and resident records. Upon review of resident records, LPA observed that 3 out of 4 residents did not have an updated needs and services/care plan. Medications reviewed. LPA observed that two medications for R3 had altered labels. Per Administrator, R3's family altered the label. The instructions on the label did not match the medication record on file. Deficiencies are being issued 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, Nelia 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 03/25/2024: 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, Mar 11, 2024

Type of visit: Case Management - Other

On 03/11/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Nelia Barcelona and Licensee, Marc Barcelona. The purpose of today's visit is to verify that S1 is no longer working in the above facility. Per, Administrator, "S1 has not been in the facility since 2019". No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Nelia Barcelona, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Mar 11, 2024