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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209341
Report Date: 08/09/2024
Date Signed: 08/14/2024 12:00:09 PM

Document Has Been Signed on 08/14/2024 12:00 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:GOLDRIDGE HOME LLCFACILITY NUMBER:
107209341
ADMINISTRATOR/
DIRECTOR:		RIEMER, ROSEMARIE H.FACILITY TYPE:
740
ADDRESS:2145 GOLDRIDGE STTELEPHONE:
(559) 317-7442
CITY:SELMASTATE: CAZIP CODE:
93662
CAPACITY: 6CENSUS: 6DATE:
08/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Administrator Rosemarie Rieme via telephone and House Manager Renee GonzalezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 08/09/24 Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a required Annual
Inspection. LPA introduced self, stated the purpose of the visit, and was greet by House manager Renee Gonzalez. Administrator Rosemarie Riemer was called and stated unable to attend meeting. Administrator authorized House manager to sign report. Two residents were present during inspection. Four residents arrived later during inspection.

LPA toured facility with staff. Residents were observed in the common area. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Medications were observed kept locked in kitchen shelves. Residents’ MARS was reviewed, and medication were audit. An adequate supply of perishable and non-perishable food was observed. Cleaning chemicals was observed stored and under kitchen sink unlock. Fire extinguisher was observed with a serviced date of 7/30/24. Extra linens observed. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. Bathroom are toured and observed functional. Non-skid mat and grabbed bars were observed. Hot water temperature was tested range between 108.8 in bathroom. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for residents. Pool fence observed secure and locked. Carbon monoxide and smoke detector operating during inspection. Half of the residents’ file were reviewed.

Due to time constraints, staff files will be reviewed at a later date.

A deficiency and an immediate Civil Penalty of $500 was assessed. See Lic 421BG is being cited on the
attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6 see attached Lic 809D. Exit Interview conducted. A copy of this report and appeal rights was emailed to Administrator.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
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 08/14/2024 12:00 PM - It Cannot Be Edited


Created By: Mai Yang On 08/09/2024 at 01:44 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: GOLDRIDGE HOME LLC
FACILITY NUMBER: 107209341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(2)
87355(e)(2) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA observed S1 working, fingerprinted cleared who is not associated to facility which poses an immediate risk to the health and safety of the residents.
POC Due Date: 08/10/2024
Plan of Correction
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S1 is to be removed from the facility immediately. S1 is not permitted back until associated. Licensee is to submit LIC 9182 Fingerprint transfer request to Fresno CCL office by POC due date 08/10/24.
Type A
Section Cited
CCR
87309(a)
87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

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 when LPA observed cleaning chemicals stored under kitchen sink unlocked at approximately 12:41PM accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2024
Plan of Correction
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Staff immediately locked chemicals. POC cleared during visit.
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:See Moua
LICENSING EVALUATOR NAME:Mai Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2024


LIC809 (FAS) - (06/04)
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