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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201055
Report Date: 06/12/2023
Date Signed: 06/19/2023 03:39:14 PM


Document Has Been Signed on 06/19/2023 03:39 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: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: 6DATE:
06/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:54 AM
MET WITH:Lead staff, Synthia MinorTIME COMPLETED:
02:15 PM
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On 06/12/2023, Licensing Program Analyst (LPA) V. Gorban arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. Administrator Julie Hergenroeder was notified of Licensing visit but was unable to attend the visit.
Facility has one entrance/exit point. LPA toured facility with Lead staff inside and out. LPA observed residents at common area having lunch and watching television.

The facility was observed to be at a comfortable temperature, free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. A 2-day supply of perishable and 7-day supply of non-perishable food was observed to be properly stored and labelled. Fire extinguisher was observed with a service date of 01/10/2023. Resident's all 4 bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting.

Garage is not utilized for any activities or events. Sample of residents files were reviewed.

No deficiencies were observed.

Report was signed and copy of this report was provided for facility records.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023
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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