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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400622
Report Date: 01/27/2025
Date Signed: 02/03/2025 09:03:54 AM

Document Has Been Signed on 02/03/2025 09:03 AM - 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:STONEHAVEN SENIOR LIVINGFACILITY NUMBER:
100400622
ADMINISTRATOR/
DIRECTOR:		CARTER, BENJAMINFACILITY TYPE:
740
ADDRESS:1717 SOUTH WINERY AVENUETELEPHONE:
(559) 251-8417
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 116TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
01/27/2025
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Jaycee Sanderson, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On January 27, 2025 Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced visit to the facility for the purpose of conducting an in person interview with a resident that was previously at another facility. LPA was allowed entry and provided access to the resident. The resident's family member had made allegations against the previous facility and the purpose of the interview was to get his opinions on the allegations. The complaint has nothing to do with Stonehaven. See 811 for confidential names list.
Sergiy PidgirnyTELEPHONE: (559) 246-0610
Rachel A BruceTELEPHONE: (559) 470-9001
DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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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