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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
107209020
Report Date:
12/23/2021
Date Signed:
12/23/2021 03:56:00 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:
ASHCROFT SENIOR LIVING
FACILITY NUMBER:
107209020
ADMINISTRATOR:
KAUR, MANINDER
FACILITY TYPE:
740
ADDRESS:
5637 W ASHCROFT AVENUE
TELEPHONE:
(559) 369-7105
CITY:
FRESNO
STATE:
CA
ZIP CODE:
93722
CAPACITY:
6
CENSUS:
0
DATE:
12/23/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:02 AM
MET WITH:
Maninder Kaur
TIME COMPLETED:
09:40 AM
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SUPERVISOR'S NAME:
Sergiy Pidgirny
TELEPHONE:
(559) 650-7923
LICENSING EVALUATOR NAME:
Katie Brown
TELEPHONE:
(559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE:
12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/23/2021
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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