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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206768
Report Date: 03/11/2024
Date Signed: 03/11/2024 02:00:20 PM


Document Has Been Signed on 03/11/2024 02:00 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 CARE IIFACILITY NUMBER:
157206768
ADMINISTRATOR:BARCELONA, NELIAFACILITY TYPE:
740
ADDRESS:14012 TOLUCA DRIVETELEPHONE:
(661) 829-6818
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY:6CENSUS: 4DATE:
03/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Administrator, Nelia Barcelona and Licensee, Marc BarcelonaTIME COMPLETED:
02:15 PM
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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.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2024
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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