<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209020
Report Date: 12/27/2021
Date Signed: 12/27/2021 10:24:43 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:ASHCROFT SENIOR LIVINGFACILITY NUMBER:
107209020
ADMINISTRATOR:KAUR, MANINDERFACILITY TYPE:
740
ADDRESS:5637 W ASHCROFT AVENUETELEPHONE:
(559) 369-7105
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 0DATE:
12/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Maninder KaurTIME COMPLETED:
10:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Infection Control Inspection. LPA met with Administrator Maninder Kaur.

There are currently no residents in care at the facility. Administrator has notified CCLD of the intent to sell the property.

LPA toured the facility inside and out. LPA observed required postings including use of face coverings and hand washing.

Mitigation Plan and Infection control procedures were reviewed with the Administrator. A Mitigation Plan will be completed and submitted to CCL by 1/5/2022.

The following forms requested to be updated and submitted to LPA by 1/5/2022: LIC 308, 309 610, 500, 9020A, a copy of current Liability Insurance, Administrator Certificate

No deficiencies cited during this inspection
A copy of this report was provided to the Administrator.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1