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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006462
Report Date: 01/10/2025
Date Signed: 01/10/2025 12:24:20 PM

Document Has Been Signed on 01/10/2025 12:24 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GOLDEN SENIOR ASSISTED LIVING IFACILITY NUMBER:
306006462
ADMINISTRATOR/
DIRECTOR:
GRADNEY, STEPHENFACILITY TYPE:
740
ADDRESS:2032 CYPRESS AVETELEPHONE:
(310) 600-3999
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 6CENSUS: 0DATE:
01/10/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Licensee Stephen GradneyTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Jenifer Tirre made a announced inspection visit to follow up on corrections identified during Pre Licensing visit on 12/18/2024. LPA identified themselves and discussed the purpose of the visit with Licensee Stephen Gradney and Assistant Administrator Nino Lozada. An initial application to operate a Adult Residential Facility was submitted to CCL on 08/14/2024. There are 0 clients in care during today's visit. LPA observed the following:

At 10:30 AM LPA toured facility with Licensee and Assistant Administrator. The following was observed:
  • Department postings are posted in central area near entrance
  • Facility Sketch was updated and reflected correlating rooms
  • Grab bars installed in restrooms
  • most face plates were repaired (one face plate in restroom 1 near toilet needs to be adjusted)
  • Emergency food was provided
  • Exit 7 has audible alarm
  • Facility had First Aid Pamphlet (Licensee ordered First Aid Manual book to be delivered 1-2 business days)
  • First Aid has required tweezers and scissors
  • Drain inside restroom 2 was repaired and operational
  • Outside crawl space piping was repaired and adjusted


Water Temperature in resident restroom 3 is still out of compliance and needs to be adjusted. During visit Assistant Administrator lowered water temperature. LPA later attempted measuring and water was too hot. Applicant to hire Plumber to repair water temperature to meet regulations.

Component III was conducted during visit. At this time facility is not ready to be licensed. Licensee to contact LPA when corrections addressing water temperature are complete. Exit interview conducted with Licensee and a copy of this report was provided to the facility.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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