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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209374
Report Date: 01/12/2024
Date Signed: 01/12/2024 03:20:07 PM

Document Has Been Signed on 01/12/2024 03:20 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:GRAND OAKS ASSISTED LIVINGFACILITY NUMBER:
547209374
ADMINISTRATOR:LAWRENCE, MICHELLEFACILITY TYPE:
740
ADDRESS:999 NORTH M STREETTELEPHONE:
(559) 684-1001
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 85CENSUS: 55DATE:
01/12/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Michelle Lawrence & Acting Administrator David ShellhamerTIME COMPLETED:
03:30 PM
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A Prelicensing visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) L. Salazar & LPA K. McClurg. LPAs met with Administrator Michelle Lawrence & Acting Administrator David Shellhamer.

Physical plant toured. Flooring in 3 out of 3 hallways, located off of resident rooms observed to be in disrepair & unsafe. Carpet is worn, frayed, pulling up & has large ridges through-out. Pulling up & areas with large ridges are unsafe & create an immediate trip/fall risk to residents.

Hot tub in fitness room observed to not be in use, requiring removal from premises.

The following must be done prior to licensure:
  1. Flooring throughout hallways off of resident rooms to be replaced
  2. Written plan with specific dates, including completion date committing to removal of hot tub. Plan to be submitted to LPA L. Salazar. Plan should also include how residents will be made safe & with minimal impact to residents during removal process

Applicant to contact LPA Lisa Salazar when both items above have been completed.
This facility is not ready to be licensed at this time. Another Prelicensing will be conducted once the above items have been completed.

Exit interview conducted with Administrator Michelle Lawrence & Acting Administrator David Shellhamer. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2024
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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