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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547201719
Report Date: 06/27/2023
Date Signed: 07/11/2023 08:34:07 AM


Document Has Been Signed on 07/11/2023 08:34 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: 55DATE:
06/27/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator Mandy RancourTIME COMPLETED:
06:00 PM
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On 06/27/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct an annual continuation inspection. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility.

LPA toured the facility with Administrator and observed the facility's Exercise Room to have a hot tub and residential furniture, inaccessible to residents. A vacated resident room was observed, containing stored PPE and overflow of bedroom furniture. Carpet is rippled.

LPA observed 12 out of 77 rooms. Of those 12 rooms, 6 out of 12 needs carpets replaced and 2 out of 3 glass panels, on the front right door, are be broken and in need of replacement. Doors are heavy and hard for open.

LPA conducted records review evidencing Grand Oaks Assisted Living, LLC is one of several business' found to be operating on the above licensed premises. Plan of operation for Twin Oaks Assisted Living was unavailable.

Exit interview conducted. Due to time restraints and technical difficulties, LPA will cite deficiencies on a subsequent visit. No deficiencies cited on todays visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 547201719
VISIT DATE: 06/27/2023
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(Continued from LIC 809)

Exit Interview conducted. Due to technical difficulties and time restraint, facility files will be reviewed at a later date. Deficiencies observed during today's visit will be issued on a subsequent report and visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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