<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209203
Report Date: 02/13/2025
Date Signed: 02/14/2025 08:56:03 AM

Document Has Been Signed on 02/14/2025 08:56 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:GOLDEN LIFE HAVENFACILITY NUMBER:
107209203
ADMINISTRATOR/
DIRECTOR:
GARCIA, CHERRY LYNNEFACILITY TYPE:
740
ADDRESS:247 W SIERRA AVENUETELEPHONE:
(559) 579-2795
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY: 6CENSUS: 5DATE:
02/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Cherry GarciaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility unannounced to conduct the Required Annual Inspection.LPA disclosed the purpose of the inspection and was granted entry into the facility by caregiver staff who contacted the Administrator to respond to the facility to assist with the visit. Licensee/Administrator Cherry Lynne Garcia arrived at the facility minutes after to complete this annual visit.

A tour of the facility was conducted with the Administrator.

The residence was set at 70 degrees F temperature and free of passageway obstructions inside and outside. LPA observed four bedrooms in the residence all of the four bedrooms are occupied. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Hot water temperature measured between 109.5 degrees F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Fire extinguishers were charged and had service dates of 3/06/24. Facility has a pull station fire alarm. Last emergency drill was conducted on 1/20/2025

Facility has a pool that is gated with lock on gate making it inaccessible to residents in care.

Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in the kitchen area. Cleaning supplies are kept locked in the garage and in their storage room. Smoke and carbon monoxide were checked and operating. . There was outdoor seating for the residents. Outdoor area was clean and free of obstruction.

During the visit a file review was conducted for residents and staff files. An exit interview was conducted, and a copy of this report was provided to Licensee whose signature confirms receipt.

LPA requested the following updated forms faxed to CCLD by 2/21/25: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1