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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400544
Report Date: 01/07/2021
Date Signed: 01/22/2021 11:41:07 AM

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:SHAUN RUSHFORTHFACILITY TYPE:
741
ADDRESS:5555 NORTH FRESNO STREETTELEPHONE:
(559) 439-4770
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:652CENSUS: 348DATE:
01/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Anna Ferrell, Assisted Living ManagerTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Lady Cabrera contacted Anna Ferrell, Assisted Living Manager by phone due to due to COVID-19 and pre-cautionary measures.

The purpose of the case management phone call is to follow-up on the health and safety check of Resident 1 (R1) and to obtain additional information. The incident occurred on 12/19/2020 and it was reported to Community Care Licensing on 12/31/2020. Assisted Living Manager will provide the additional information by 01/08/2021.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021
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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