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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006417
Report Date: 10/16/2024
Date Signed: 10/16/2024 10:56:32 AM

Document Has Been Signed on 10/16/2024 10:56 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GOLDEN YEARS GROUPFACILITY NUMBER:
306006417
ADMINISTRATOR/
DIRECTOR:
ATTRAH, AMEERFACILITY TYPE:
740
ADDRESS:507 S. CITADELL LANETELEPHONE:
(949) 994-2900
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 6CENSUS: 5DATE:
10/16/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Ameer Attrah TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Lydia Martinez and Samer Haddadin conducted an unannounced visit for the purpose of a Post Licensing. LPAs met with caregiver, Stefania Paniagva, where we were greeted and granted entry into the facility. The facility is a one-story house with a detached garage with 1 caregiver room, 5 resident bedrooms, 3 full bathrooms, a living room, a dining room/kitchen. The resident’s bedrooms are spacious and easily accommodate the resident’s furnishings.

There is a large back yard with seating for the residents and an exit walkway on each side of the house. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms accommodate 6 residents, which at time of visit facility had 5 resident in care.

All bathrooms had a working toilet, wash basin, walk in shower. Facility had adequate supply of linen in storage. LPAs Checked emergency food supplies and noted that facility had an adequate supply of 7-day non-perishable and 2-day perishables and extra water supply are stored in the kitchen. LPAs checked Smoke detectors and carbon monoxide alert systems were hardwired, were tested, and found operational. 1 fire extinguishers mounted in kitchen and last inspected was July 18th, 2024. Water temperature was tested and was within regulatory requirements.

Chemicals and toxins are locked up in the hallway closet. LPAs noted the facility's knives and sharps are in the kitchen secured and locked. Medication for each client is kept locked in medication cart in staff office as well as staff and clients’ files. The backyard has one shaded seating area, and the exit gate is unlocked and unobstructed. No bodies of water observed. LPAs reviewed two clients’ files and medications no discrepancies observed. LPAs reviewed two staff files. All files of staff and clients contained all required documentation. Emergency drill was last conducted in June but no physical documentation noted. An advisory note was given.

No deficiencies were noted during today's inspection visit. An exit interview was conducted, and a copy of this report was provided to Administrator (AD) Amir Attrah, who joined at the end of visit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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