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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004863
Report Date: 03/08/2022
Date Signed: 03/08/2022 01:18:27 PM

Document Has Been Signed on 03/08/2022 01:18 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:GOLDEN VILLA RCFE AT NATOMAS PARKFACILITY NUMBER:
347004863
ADMINISTRATOR:FLORES, JULIETA A.FACILITY TYPE:
740
ADDRESS:5618 JOHN RUNGE ST.TELEPHONE:
(916) 239-9372
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 6CENSUS: 4DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Julieta Flores, AdministratorTIME COMPLETED:
01:45 PM
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On March 8, 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct an Annual Required Inspection. LPA met with Julieta Flores, Administrator and explained the reason for the visit. Prior to the visit, LPA Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following
LPA did not completed the inspection tool questionnaire due to computer problems. Julieta ensured LPA that nothing has changed since the last Annual completed in September 2021.

LPA observed the following:
Administrator certificate is valid expiring 10/26/2023. First aid kit fully stocked and ready for emergency use. Fire extinguishers fully charged. .Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has required (2) day perishable supply of food and (7) supply of Non-perishable food. Medication was properly stored and locked away. All residents are vaccinated and boosted.
As a result of this visit, no deficiencies were cited, per Title 22 Regulations.
Exit interview conducted and a copy of this report given to Julieta Flores
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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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