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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547201719
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:43:50 AM


Document Has Been Signed on 03/30/2022 11:43 AM - It Cannot Be Edited

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:TWIN OAKS ASSISTED LIVING CENTERFACILITY NUMBER:
547201719
ADMINISTRATOR:MANDY RANCOURFACILITY TYPE:
740
ADDRESS:999 NORTH M STREETTELEPHONE:
(559) 684-1001
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY:85CENSUS: 45DATE:
03/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Rosanna Renteria, Business Office Manager TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Lady Cabrera conducted a subsequent Case Management visit. LPA introduced herself to Rosanna Renteria, Business Office Manager and stated the purpose of the visit. Administrator Michelle Lawrence from Skill Nursing reported Administrator Mandy Rancour was unavailable, and Rosanna Renteria was able to sign this report.

LPA obtained resident's physician's report and staff contact information. LPA interviewed three residents out of four.

Follow-up is required once LPA conducts interviews and review records.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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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