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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400544
Report Date: 04/07/2021
Date Signed: 04/29/2021 10:33:55 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: 353DATE:
04/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Shaun Rushforth, AdministratorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Lady Cabrera conducted a Case Management visit via telephone due to COVID-19 and pre-cautionary measures. LPA spoke with Administrator Shaun Rushforth.

On 03/29/2021, Community Care Licensing received the Death Report. The purpose of the phone call is to obtain additional information regrading the resident. Administrator reported he will have another staff contact the LPA to provide further information regarding the death report.

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

DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021
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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