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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247201669
Report Date: 12/06/2021
Date Signed: 12/07/2021 01:08:44 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:MISSION GARDENSFACILITY NUMBER:
247201669
ADMINISTRATOR:ELINA MOILANENFACILITY TYPE:
740
ADDRESS:1450 EAST 27TH STREETTELEPHONE:
(209) 384-3300
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:15CENSUS: 0DATE:
12/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator, Elina MoilanenTIME COMPLETED:
04:01 PM
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On 12/6/21 Licensing Program Analyst (LPA) M. Garza arrived at facility to complete an unannounced visit. LPA met with Administrator, Elina Moilanen and purpose of the visit was discussed. LPA conducted a tour of the facility with Administrator.

Tour began touring residents rooms to verify that all residents have been moved from Facility to sister facility (Park Merced). LPA observed empty rooms with out clothing or personal belongings. Tour ended in kitchen where LPA observed no food in the refrigerators and cupboards.

Administrator provided LPA with copy of new Admission Agreements for residents that were moved. Exit interview completed.

Due to COVID precautionary measures a copy of this report will be emailed to: elina@amiesseniorcare.com. A delivered and read receipt serves as confirmation.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
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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