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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209339
Report Date: 08/22/2024
Date Signed: 08/22/2024 01:08:33 PM

Document Has Been Signed on 08/22/2024 01:08 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:GOLDEN DAYS CARE HOME, THEFACILITY NUMBER:
107209339
ADMINISTRATOR/
DIRECTOR:		GALVEZ, MARLENEFACILITY TYPE:
740
ADDRESS:8647 N RICHELLE AVETELEPHONE:
(559) 250-1527
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 6CENSUS: 6DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:03 AM
MET WITH:Administrator Carlo SantosTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 08/22/2024 Licensing Program Analysts (LPAs) M. Vega & S. Hurt arrived at the facility unannounced to conduct a required Annual Inspection. LPAs introduced themselves and stated the purpose of visit. LPAs were allowed into the facility and new Licensee Carlo Santos was contact and arrived at a later time.


Facility current capacity is 6 with a current census of 6. Facility has 6 bedrooms and 2 bathrooms, 6 of the bedrooms are for residents. 1 resident on Hospice at the time of inspection.

LPA toured the facility inside and out including entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior. LPAs observed the facility to be clean, clutter, and odor free.

All fire exit routes were free and clear of obstructions. Smoke detectors and carbon monoxide detectors were tested and are in working condition. Fire extinguishers have been services as of 04/04/2024 and are in good standing. Smoke alarms are in working condition. LPAs observed knives and cleaning supplies to be locked and inaccessible to residents. Medications are stored in a locked cabinet in the kitchen/dining area. Water temperature in the common bathroom was checked and read at 125 degrees Fahrenheit.

Citation was issued per the California Code of Regulations Title 22.

Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights was/were provided to Carlo Santos.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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Document Has Been Signed on 08/22/2024 01:08 PM - It Cannot Be Edited


Created By: Martin Vega On 08/22/2024 at 12:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: GOLDEN DAYS CARE HOME, THE
FACILITY NUMBER: 107209339

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/04/2024
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brenda Chan
LICENSING EVALUATOR NAME:Martin Vega
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024


LIC809 (FAS) - (06/04)
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