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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209374
Report Date: 10/29/2024
Date Signed: 10/31/2024 11:47:22 AM

Document Has Been Signed on 10/31/2024 11:47 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:GRAND OAKS ASSISTED LIVINGFACILITY NUMBER:
547209374
ADMINISTRATOR/
DIRECTOR:
SHELLHAMER, DAVIDFACILITY TYPE:
740
ADDRESS:999 NORTH M STREETTELEPHONE:
(559) 684-1001
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 85CENSUS: DATE:
10/29/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Wendi Valdez, Residential Care CoordinatorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 10/29/24 Licensing Program Analyst (LPA) arrived at the facility unannounced to conduct the Post Licensing inspection. LPA was greeted by Residential Care Coordinator (RCC), stated the purpose of the visit and was allowed entry into the facility. Administrator on record is David Shellhamer, who is available via telephone on today's visit.

LPA toured the facility inside and out. All passageways and exits are clear and free from obstruction. Facility was adequately furnished and lit. Fire extinguishers had current service tag dates. Facility had operational smoke detectors. LPA observed all hazardous materials and cleaning supplies to be secured in locked storage closets. LPA observed the dining room to be clean. 8 residents were observed drinking coffee at tables while dinner was being prepared. LPA observed a seven day supply of nonperishable food and a two day supply of perishable food. Medications were observed to be kept in a locked medicine cart located near a locked medication room. Facility was decorated for the holidays, activities room carpet neat the med cart was observed to be stained. Administrator assigned the cleaning to staff at the time of visit.

LPA toured the outside and observed a shaded seating area with pathways and exits free from obstruction.
This is one of 3 visits LPA is conducting at the facility on this date, LPA is documenting the physical plant facility tour, facility records will be reviewed at a later date on a continuation visit. No deficiencies cited during the inspection. Exit interview conducted. A copy of the report was provided to the licensee via email.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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