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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400544
Report Date: 11/22/2022
Date Signed: 11/22/2022 01:15:24 PM


Document Has Been Signed on 11/22/2022 01:15 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:TERRACES AT SAN JOAQUIN GARDENS, THEFACILITY NUMBER:
100400544
ADMINISTRATOR:JESSICA LOPEZFACILITY TYPE:
741
ADDRESS:5555 NORTH FRESNO STREETTELEPHONE:
(559) 439-4770
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:652CENSUS: 57DATE:
11/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Valerie Epps, Director of Wellness and Assisted Living TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Lady Cabrera conducted an unannounced case management visit to the facility.The purpose of the case management visit is to follow up on Special Incident Reports (SIR) submitted to CCL Office.

LPA met with Valerie Epps, Director of Wellness and Assisted Living and stated the purpose of the visit. Administrator Jessica Lopez was unavailable at the time of the visit.

SIR 1: Independent Living Resident (R1) was backing their vehicle up and accidently hit Assisted Living Resident (R2) with the vehicle. Facility staff called 911 immediately. EMS and Fire responded to call. Fresno Police Department responded and deemed the incident as an accident. R2 was discharge from hospital the same day and did not sustain any fractures or broken bones.

SIR: Resident (R3) sustained a fall, hit his head and had a ¾ inch laceration. Facility staff applied first aid and notified hospice. R3 was monitor for delayed injury.

No deficiencies observed.

Exit interview conducted. A copy of this report was provided to Valerie Epps.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 513-9832
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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