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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100408901
Report Date: 09/04/2020
Date Signed: 09/08/2020 10:07:46 AM

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:GARDEN MANORFACILITY NUMBER:
100408901
ADMINISTRATOR:BLACK, JOANFACILITY TYPE:
740
ADDRESS:4983 E. OLIVETELEPHONE:
(559) 255-8650
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:49CENSUS: 47DATE:
09/04/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Joanna Tilghman
Office Manager/Care Provider		TIME COMPLETED:
10:49 AM
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Licensing Program Analyst conducted a case management - Health and Safety check inspection on this date, in conjunction, with an initial complaint inspection. LPA spoke with Program Manager Joanna and informed her of the purpose of the inspection. Administrator Joan was notified of the inspection and permission was given for Joanna to sign the report.

COVID-19 guidelines are in place at the facility. Tour was conducted. Facility has an adequate supply of food. Residents were observed to be doing well. There appears to be no staffing issues.

No immediate Health & Safety concerns were observed. Exit Interview was conducted.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: See MouaTELEPHONE: (559) 650-7904
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2020
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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