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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201055
Report Date: 06/11/2021
Date Signed: 06/23/2021 04:28:35 PM

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 TERRACE ASSISTED LIVING IIFACILITY NUMBER:
107201055
ADMINISTRATOR:HERGENROEDER, STEVE & JULIFACILITY TYPE:
740
ADDRESS:1743 E. CHENNAULTTELEPHONE:
(559) 323-1083
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 5DATE:
06/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Assistant Administrator, Martha Zapata and Administrator, Juli HergenroederTIME COMPLETED:
12:30 PM
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On 6/11/2021, Licensing Program Analyst (LPA) arrived unannounced to conduct an Annual Inspection. LPA was met by staff Margaret, introduced self, and stated the purpose of the visit. Administrator was not available to met with LPA.

LPA returned to the facility at approximately 11:30 AM and met with Assistant Administrator, Martha Zapata. Licensee, Juli Hergenroeder arrived a short time later. LPA introduced self and stated the purpose of the visit. Facility has one entrance/exit point. Visitor log-in/temperature check was upon entry.

Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by the bathroom sink. Bedrooms were checked and beds are six feet apart.



LPA checked residents’ locked medications. Food supply was checked. Cleaning and PPE supplies were checked. Facility has an adequate supplies of required PPE. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents wear masks when away from the facility. Resident’s files have updated emergency contact information. Administrator certification is current.

No deficiencies were observed. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. Facility Representative signature on file.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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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