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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206271
Report Date: 09/03/2020
Date Signed: 09/15/2020 03:05:03 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:AUTUMN RIDGE ASSISTED LIVINGFACILITY NUMBER:
107206271
ADMINISTRATOR:HUNT, STEVENFACILITY TYPE:
740
ADDRESS:14280 W. STANISLAUS STREETTELEPHONE:
(559) 842-7727
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY:34CENSUS: 20DATE:
09/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Steven Hunt & General Partner Barry ByersTIME COMPLETED:
12:30 PM
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On this date a Case Management visit was conduced. Licensing Program Analyst (LPA) K. McClurg, Licensing Program Manager (LPM) A. Xiong; Fresno Regional Manager B. White met with Jennifer Anolin with Fresno County Public Health, Registered Nurse Shantala Ahanya with CA Department of Public Health Healthcare-Associated Infection (HAI) prevention program, & facility Administrator Steven Hunt & General Partner Barry Byers.

The purpose of this visit was to tour facility & review facility status.
Exit interview conducted with Administrator Steven Hunt.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020
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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