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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400622
Report Date: 04/20/2023
Date Signed: 04/20/2023 04:31:57 PM


Document Has Been Signed on 04/20/2023 04:31 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
SIERRA CASCADE AC/SC, 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:
04/20/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Sylvia Ramirez, AdministratorTIME COMPLETED:
04:45 PM
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On 4/20/23 at 3:00 PM, Licensing Program Analyst (LPA) Malia Thao and Licensing Program Manager (LPM) Melinda Hoffmann arrived unannounced to conduct a case management - health checks inspection. LPA and LPM explained reason for inspection and met with Administrator (ADM) Sylvia Ramirez, Administrator Teresa Long, and CEO Kristine Williams.

LPA and LPM conducted a tour of the facility with ADM Sylvia Ramirez. LPA and LPM observed a sample of resident rooms, activities room, med rooms, and kitchen.

The following documents are requested to be submitted to the Fresno Regional Office by close of business tomorrow, 4/21/23:

1. Bank statements for last six months, to include skilled nursing facility and independent living
2. Utility statements for last three months, to include gas, water, trash, electricity, cable/internet, phone
3. Payroll journal for March and April 2023
4. Any outstanding loan statements with amounts
5. Food invoices for March and April 2023
6. Rent roll for all assisted living residents, to include name and amount
7. LIC500 for March and April 2023
8. List of all residents in assisted living and independent living, to include responsible party and contact information for assisted living residents; and contact information for independent living
9. LIC401
10. LIC403

No deficiencies cited during this inspection. Exit interview conducted. A copy of this report was given to Administrator Sylvia Ramirez, whose signature confirms receipt of this report.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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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