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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400622
Report Date: 07/12/2023
Date Signed: 07/12/2023 06:32:51 PM


Document Has Been Signed on 07/12/2023 06:32 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
CCLD Regional Office, 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: 30DATE:
07/12/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:RCFE Operations Manager (OM) Kristine WilliamsTIME COMPLETED:
06:30 PM
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An unannounced Case Management - Health & Safety visit was conducted on the date & time indicated by Licensing Program Analyst (LPA) K. McClurg. LPA met with RCFE Operations Manager (OM) Kristine Williams. LPA introduced self & stated purpose of visit.

Facility tour conducted. Facility appeared to be clean including floors, ceilings, dining room, kitchen, etc. in good condition. No miscellaneous debris observed throughout facility. Facility temperature was comfortable & cool. Resident rooms appeared to be in good condition. No unpleasant odors detected during walk-through. Food supplies appear to be sufficient & appropriately stored. Sufficient supply of paper goods.

Facility has not experienced any interruption of services such as food, water, electrical, phone services, television, public utilities &/or services. Continues to receive food deliveries weekly.

Residents appeared to be clean & groomed. Staffing appeared to be sufficient to meet current resident needs.

No hazards observed at time of visit.

Exit interview conducted with OM. Copy of report provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
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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