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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247209290
Report Date: 04/20/2026
Date Signed: 04/20/2026 06:01:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2026 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20260413155738
FACILITY NAME:A GOLDEN CAREFACILITY NUMBER:
247209290
ADMINISTRATOR:KALINGA, ADELINAFACILITY TYPE:
740
ADDRESS:892 VALPARAISO COURTTELEPHONE:
(408) 896-1531
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:6CENSUS: 4DATE:
04/20/2026
UNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Administrator Becky WoodsTIME COMPLETED:
03:19 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff falsified documents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/20/2026 Licensing Program Analyst (LPA) Gorban unannounced visited the facility to commence to complaint investigation. LPA introduced self and met with facility staff. LPA stated purpose of the visit and was allowed entry. Administrator as notified and able to attend the visit.

During this complaint investigation LPA toured the facility conducting health and safety checks, reviewed facility records, and interviewed administrator and staff.
Allegation: Facility staff falsified documents. Based on interviews and record reviews administrator maintains facility documents as required. Although the alleged violation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occur, therefore the allegation is Unsubstantiated.

Exit interview conducted, report signed and copy of this report provided to health services director for facility records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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