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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202402
Report Date: 01/24/2024
Date Signed: 01/24/2024 01:09:16 PM


Document Has Been Signed on 01/24/2024 01:09 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:JASMINE GARDEN RESIDENTIAL CAREFACILITY NUMBER:
157202402
ADMINISTRATOR:BARCELONA, MARC OR NELIAFACILITY TYPE:
740
ADDRESS:14016 TOLUCA DRIVETELEPHONE:
(661) 410-8297
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY:6CENSUS: 4DATE:
01/24/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:41 PM
MET WITH:Administrator, Marc Barcelona.TIME COMPLETED:
01:23 PM
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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.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024
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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