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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209339
Report Date: 07/25/2023
Date Signed: 07/25/2023 05:29:39 PM

Document Has Been Signed on 07/25/2023 05:29 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:GOLDEN DAYS CARE HOME, THEFACILITY NUMBER:
107209339
ADMINISTRATOR:GALVEZ, MARLENEFACILITY TYPE:
740
ADDRESS:8647 N RICHELLE AVETELEPHONE:
(559) 250-1527
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 6CENSUS: 0DATE:
07/25/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee, Marlene GalvezTIME COMPLETED:
03:30 PM
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On 7/25/23, Licensing Program Analyst (LPA) V Gorban conducted an announced Pre-licensing visit. LPA met with Licensee Marlene Galvez, certification number 6021132740, expiration date 11/02/2024 and discussed the purpose of the visit.

LPA began the tour at the entrance of the facility that has one entrance point. LPA toured the inside and outside of the facility. LPA observed no obstruction to emergency exit from back yard of the facility on both sides.
Facility was observed at a comfortable temperature, clean of 79 degrees F, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas furnished and well-lit throughout. LPA observed the kitchen to be absent of any trash or debris, sharp objects are secured and inaccessible to residents. A seven-day supply of non-perishable food were observed.
Medications and chemicals were kept locked in separate cabinets. Resident’s all six individual bedrooms supplied with call light response system. Rooms were observed to be furnished with bed, dresser, night stand, and overhead lightning. Mattresses, box springs, sheets, and linens, were absent of any tears and stains.
Bathrooms and showers were equipped with non-skid mats and securely fastened grab bars. Bathroom water temperature was tested at 112 degrees F. Towels, linens, and personal hygiene supplies were observed in storage. There are no bodies of water outside.
All Fire extinguishers are current with service date of 04/04/23. Carbon monoxide and smoke detectors were observed to be operational. First Aid Kit was checked and observed to have the required supplies. Emergency exit plan, required phone numbers, and required postings were observed. A working telephone number (559-322-5081) was present and functional.

Component III was reviewed with Licensee and Administrator. Exit interview conducted. No deficiencies were observed on this visit. Report will be submitted to Centralize Application Bureau for record and further processing of application.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
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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