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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006462
Report Date: 01/28/2025
Date Signed: 01/28/2025 07:59:53 AM

Document Has Been Signed on 01/28/2025 07:59 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 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:
01/28/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:20 AM
MET WITH:Licensee Stephen GradneyTIME VISIT/
INSPECTION COMPLETED:
08:15 AM
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Licensing Program Analyst (LPA) Jenifer Tirre made a announced inspection visit to follow up on correction identified during last Pre Licensing visit on January 10, 2025. LPA identified themselves and discussed the purpose of the visit with Licensee Stephen Gradney. An initial application to operate a Residential Care for the elderly was submitted to CCL on 08/14/2024. There are 0 clients in care during today's visit. LPA observed the water temperature inside resident bathroom measured at 106.7 degrees Fahrenheit. Water temperature is within Title 22 regulations.

Comp III was conducted during visit on January 10, 2025. Facility is ready to be licensed. Exit interview conducted with Licensee Stephen Gradney and a copy of this report was provided to the facility.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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