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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208773
Report Date: 05/20/2023
Date Signed: 05/20/2023 12:12:46 PM


Document Has Been Signed on 05/20/2023 12:12 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:JASMIN TERRACE AT BAKERSFIELDFACILITY NUMBER:
157208773
ADMINISTRATOR:ELECO, RAMONA D.FACILITY TYPE:
740
ADDRESS:5400 STINE ROADTELEPHONE:
(661) 398-8802
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:99CENSUS: 80DATE:
05/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:39 AM
MET WITH:Administrator Ramona Eleco TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced visit to follow up on a case management that occurred on 5/9/23. LPA conducted a case management to address the deficiencies. LPA met with Administrator Ramona Eleco.

LPA reviewed and obtained copies of C1's file. LPA interviewed staff and resident. After conducting interviews it was found C1 was retained with a prohibited health condition. Administrator was unable to provide documentation of a health care plan for C1. Administrator did not contact Licensing prior to C1 being released from the hospital to obtain an exception for C1.

Due to time constraints and further review needed, LPA will return at a later date to issue citations and possible civil penalties if warranted.

An exit interview was conducted with the Administrator and a copy of this report was provided to Administrator Ramona Eleco.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2023
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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