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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400622
Report Date: 11/17/2021
Date Signed: 11/22/2021 08:45:46 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:TWILIGHT HAVENFACILITY NUMBER:
100400622
ADMINISTRATOR:RAMIREZ, SYLVIAFACILITY TYPE:
740
ADDRESS:1717 SOUTH WINERY AVENUETELEPHONE:
(559) 251-8417
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:116CENSUS: 34DATE:
11/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Sylvia Ramirez-Director of WellnessTIME COMPLETED:
10:45 AM
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Licensing Program Analyst's(LPA's) D. Ayers and K. Kaur arrived unannounced for a Required Annual Inspection. LPA's met with Administrator Sylvia Ramirez. Administrator certificate was current with renewal date 7/21/2023. A tour of the facility was conducted together.

Facility was observed at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. There was adequate lighting and seating in the common area. Fire extinguisher were observed to be fully charged and serviced. First Aid kit was observed with the required supplies. The kitchen was toured. An adequate supply of perishable and non-perishable food supply was observed. Emergency food supply was also observed. Menu was observed. A sample of resident rooms were toured. Rooms were observed to be adequately furnished with bed, dresser, and adequate lightning. Bathrooms were properly equipped with non-skid mats and securely fastened grab bars. Medications were kept in a locked medication room. LPA's reviewed infection control guidance and best practices with Administrator.

LPA's requested the following forms to be submitted within 2 weeks: LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly, LIC 9020 Register of Facility Clients/Residents, Copy of current Liability Insurance, Staff Roster

No deficiency was observed. Exit Interview conducted. A copy of the report was provided via email.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
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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