<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400544
Report Date: 09/17/2021
Date Signed: 09/17/2021 10:38:22 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: 360DATE:
09/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Shaun Rushforth, AdministratorTIME COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Lady Cabrera conducted an unannounced case management visit to the facility.

The purpose of the case management visit is to respond an incident report that was submitted to CCL Office and was dated approximately 08/15/2021.

LPA met with Administrator Shaun Rushforth and stated the purpose of the visit. LPA interviewed Administrator regarding Staff (S1) witnessing S2 grabbing onto Resident (R1) arm to turn her over the bed. According to S1, R1 seemed frustrated and resistant to care provider. It was reported that R1 has dementia, she is currently taking a daily aspirin, a known blood thinner, which could make her more susceptible to bruising.

Administrator stated the facility conducted an internal investigation. Administrator will obtain documentation and submit to CCLD by Tuesday, 09/21/2021. Based on the timing of the events, R1 cognitive impairments, and her history of swinging her arms it is impossible to determine whether or not the bruising was as a result of S2 holding onto R1’s arm during care.

LPA will follow-up with Administrator.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1