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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209374
Report Date: 04/17/2024
Date Signed: 04/17/2024 05:22:14 PM

Document Has Been Signed on 04/17/2024 05:22 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/
DIRECTOR:		LAWRENCE, MICHELLEFACILITY TYPE:
740
ADDRESS:999 NORTH M STREETTELEPHONE:
(559) 684-1001
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 85CENSUS: 51DATE:
04/17/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:32 PM
MET WITH:David Shellhammer, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:18 PM
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On 04/17/24, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to complete the pre licensing inspection that was initiated on 01/12/24. LPA was greeted by Administrator and allowed entry into the facility.

LPA toured the facility inside and out and observed new flooring throughout the facility. LPA will contact Sacramento to advise facility is ready for license. LPA will return to review files on a post licensing visit.

LPA conducted exit interview with Administrator and will email a copy of this report by 04/18/24.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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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