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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607206
Report Date: 02/09/2023
Date Signed: 02/09/2023 01:02:31 PM

Document Has Been Signed on 02/09/2023 01:02 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:GOLDEN CARE LIVING, INC.FACILITY NUMBER:
197607206
ADMINISTRATOR:ANGELIQUE S. GRADNEYFACILITY TYPE:
740
ADDRESS:2052 REDONDELA DRIVETELEPHONE:
(310) 989-1941
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY: 6CENSUS: 4DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Cathy EspinoTIME COMPLETED:
01:00 PM
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On 2/9/2023 LPA Alfonso Iniguez conducted an unannounced annual visit. LPA met with Administrator/Cathy Espino and Caregiver/Rachel Lugtu. There are currently (4) residents residing in the facility. The facility is licensed to serve (6) elderly residents 60 and over. The facility is approved to support (1) hospice, (1) bedridden resident and (4) non-ambulatory residents. At this time, there is (3) non-ambulatory, and (1) bedridden hospice resident living at this facility.

The facility is a single-story structure located in a residential neighborhood. It consists (5) resident bedrooms, (3) full bathrooms, kitchen, dining area, living room, and patio area with shade located in backyard. The facility entrance and exits are wheelchair accessible. The facility has (1) garage that is utilized for supplies.

LPA observed required posting at the entrance and throughout the facility. The facility smoke detectors and carbon monoxide detectors were tested are operational. The light switches contain night-light in hallways . Restroom #1, #2 and #3 has non-skid mats and grab bars. Fire extinguisher is up to code.

LPA observed a sign-in/sanitation station at the facility entry. Facility has screening process for visitors, sanitizer/soap, paper towels, and additional PPE supplies are stored in the garage. The facility is prepared to provide a private room for isolation if needed. The facility mitigation plan was approved by CCL on 4/11/2021.

No citations were issued during this visit. An exit interview was conducted with Cathy Espino and copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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