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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400622
Report Date: 04/14/2023
Date Signed: 04/14/2023 08:18:23 PM


Document Has Been Signed on 04/14/2023 08:18 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:RAMIREZ, SYLVIAFACILITY TYPE:
740
ADDRESS:1717 SOUTH WINERY AVENUETELEPHONE:
(559) 251-8417
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:116CENSUS: 34DATE:
04/14/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
05:15 PM
MET WITH:Sylvia Ramirez, LVN RCFE Administrator (Admin); Teresa Long SNF-Administrator; Kristine Williams RCFE/SNF Operations;TIME COMPLETED:
08:30 PM
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An unannounced Health & Safety visit was conducted on the date & times indicated above. Licensing Program Analyst (LPA) K. Mcclurg met with RCFE Administrator (Admin) Sylvia Ramirez. LPA stated purpose of visit & was allowed to proceed with visit. LPA also met with Skilled Nursing Facility Administrator Teresa Long & RCFE/SNF Operations personnel Kristine Williams. Discussed current any issues & questions staff may have had.

Physical Plant toured. Facility determined to be a comfortable temperature set within regulation guidelines. Power observed to be on including industrial refrigerator & freezer maintained at appropriate temperatures. Facility pantry, refrigerator, & freezer observed to have food available for current census. Facility appeared to be maintained outside. Facility appeared to be clean with no unpleasant odors detected. Facility staffing indicated to be adequate to meet residents needs.

Exit interview conducted with Admin. Report provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
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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