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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400622
Report Date: 05/30/2023
Date Signed: 05/31/2023 03:31:32 PM


Document Has Been Signed on 05/31/2023 03:31 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 HAVENFACILITY NUMBER:
100400622
ADMINISTRATOR:LONG, TERESAFACILITY TYPE:
740
ADDRESS:1717 SOUTH WINERY AVENUETELEPHONE:
(559) 251-8417
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:116CENSUS: 32DATE:
05/30/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Teresa Long, Skilled Nursing Administrator and Terry Darosa, Medication TechicianTIME COMPLETED:
12:20 PM
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On 05/30/23, Licensing Program Analyst (LPA) M. Yang 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 Teresa Long, Skilled Nursing Administrator (SNA). LPA toured facility with Terry Darosa, Med Tech.

LPA observed a sample of resident rooms, bathrooms, activities room, medication rooms, kitchen, and dining area. Facility appeared to be clean with no obstruction. Facility was observed to have operating and functioning electricity power during inspection.



Food supply was checked and appeared to have an adequate supply in facility pantry, refrigerator, and freezer. Outside was toured and appeared to be maintained. LPA observed adequately seatings outside for residents. Facility staffing indicated to be adequate to meet resident’s needs.

No deficiencies cited during today's inspection.

Exit interview conducted. A copy of this report was provided to Skill Nursing Administrator, whose signature on this form confirms receipt of these report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023
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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