100400622-5-1-2023-24-AS-KKAR-CRF2JP-20230501172641

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100400622
Report Date: 05/01/2023
Date Signed: 05/01/2023 05:26:54 PM

Document Has Been Signed on 05/01/2023 05:26 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	TWILIGHT HAVEN		FACILITY NUMBER:	100400622
ADMINISTRATOR:	RAMIREZ, SYLVIA		FACILITY TYPE:	740
ADDRESS:	1717 SOUTH WINERY AVENUE		TELEPHONE:	(559) 251-8417
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	116	CENSUS: 32	DATE:	05/01/2023
TYPE OF VISIT:	Case Management - Health Checks	UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Kristine Williams RCFE/SNF Operations		TIME COMPLETED:	05:30 PM

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On 05/1/23, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct case management visit for the purpose of checking on the health and safety of the residents in care. LPA introduced self, stated the purpose of the visit, and met with Kristine Williams RCFE/SNF Operations. LPA toured facility with Mrs. Williams.

Facility staffing indicated to be adequate to meet resident’s needs. LPA toured facility and observed facility to be clean and odor free. Facility appeared clean with no obstruction or fire clearance issues. LPA toured resident rooms of 4 residents. No prohibited items were noted in any resident rooms. Emergency exits were unobstructed. All bedrooms were at a comfortable temperature and supplied with adequate furnishing. Residents’ bathroom water temperature was measured and was within 105 to 120 range. Facility kitchen was toured. Food supply was checked and there appeared to be an adequate supply. Outside of the facility was toured. Facility appeared to be maintained outside.

No deficiencies cited during today's inspection.

Exit interview conducted. A copy of this report was provided, whose signature on this form confirms receipt of these report.

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep Kaur	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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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