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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400622
Report Date: 10/18/2023
Date Signed: 10/18/2023 02:30:38 PM


Document Has Been Signed on 10/18/2023 02:30 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
FRESNO RO, 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:
10/18/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Beth Mueller, Accounts PayableTIME COMPLETED:
03:00 PM
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On 10/18/2023, Licensing Program Analysts (LPA) L. Padgett and M. Yang arrived unannounced to conduct case management visit for the purpose of checking on the health and safety of the residents in care. LPAs introduced self, stated the purpose of the visit, and met with Beth Mueller Accounts Payable (AP). CEO Kristine Williams was called and unable to attend inspection. CEO authorized AP to signed and receive report. LPAs toured facility with AP.

LPAs observed a sample of six resident rooms, bathrooms, activities room, medication rooms, dining room, and kitchen. Facility appeared to be clean with no unpleasant odors detected. Facility was observed to have operating and functioning electricity power. Bathrooms observed to be operating and functioning during inspection. Food supply was checked. Facility pantry, refrigerator, & freezer observed to have food available and appeared to be an adequate supply. Facility appeared to be maintained outside. 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 AP, whose signature on this form confirms receipt of these report.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett PadgettTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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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