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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547201719
Report Date: 07/24/2023
Date Signed: 07/24/2023 01:47:41 PM


Document Has Been Signed on 07/24/2023 01:47 PM - 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:
07/24/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:Licensee, Kenny Moyle and Administrator, Michelle LawrenceTIME COMPLETED:
01:50 PM
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An informal conference was conducted today in the Fresno Adult and Senior Care Regional Office. The purpose of this informal conference is to discuss the multiple Type A and B citing’s over the past year, as well as the pending change of ownership, and the recent addition of a CNA training program now located inside the facility. Present at the meeting was Licensing Program Manager (LPM), Melinda Hoffmann, Licensing Program Analyst (LPM), Alexandria Walton, Licensee, Kenny Moyle, and Administrator, Michelle Lawrence.

The following was discussed:
· Deficiencies including Fire Clearance, Hospice Care, Emergency Disaster Plan, Plan of Operation, Change of Ownership/control of property requirements, Physical Plant, Incidental Medical and Dental, Maintenance and Operation.
· Pending Change of Ownership-Facility responsibilities.
· Training Program-Criminal Record Clearances.

The facility agreed to the following to achieve continued and substantial compliance:

· Submit all plans of correction that are currently due. Note that any that are past due may be subject to civil penalties.
· Facility must maintain control of the property and not make any changes to correspondence or signage at the facility until the change of ownership has been approved.
· Maintain liability insurance for Twin Oaks Assisted Living Center.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2023
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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