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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547200264
Report Date: 07/29/2021
Date Signed: 07/29/2021 12:47:23 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:RIVERSEDGE ELDERCAREFACILITY NUMBER:
547200264
ADMINISTRATOR:PRESTAGE, MARY ELLENFACILITY TYPE:
740
ADDRESS:285 SOUTH WESTWOODTELEPHONE:
(559) 788-0611
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:6CENSUS: 0DATE:
07/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Mary Ellen PrestageTIME COMPLETED:
11:59 AM
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Licensing Program Manager (LPM) M. Hoffmann and Licensing Program Analyst (LPA)
M. Medina conducted an unannounced Case Management visit on this date to follow up on facility closure plan to be effective 8/5/21. LPA Medina informed Licensee, Mary Ellen Prestage of the purpose of the visit.

Mary Ellen reported that all residents have moved, after which a tour of facility was conducted and it was confirmed that no residents were present.

Facility closure will be processed upon return to the licensing office.

Exit interview conducted.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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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