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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881548
Report Date: 10/21/2024
Date Signed: 10/21/2024 11:21:41 AM

Document Has Been Signed on 10/21/2024 11:21 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:GOLDEN HOUSE RESIDENCE 3FACILITY NUMBER:
371881548
ADMINISTRATOR/
DIRECTOR:		KARATAS, YUSUFFACILITY TYPE:
740
ADDRESS:908 CANYON HEIGHTS RDTELEPHONE:
(203) 606-9547
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 6CENSUS: 0DATE:
10/21/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:24 AM
MET WITH:Yusuf Karatas, Administrator TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 10/21/24 at 9:24am Licensing Program Analyst (LPA) Javina George made an announced visit to the facility to conduct a prelicensing inspection. LPA met with Applicant Yusuf Karatas whom accompanied LPA throughout today's inspection. The applicant has applied for a Residential Care for the Elderly (RCFE), aged 60 and above. On 06/05/24 The North County Fire Protection District approved the facility for (5) non ambulatory and (1) bedridden resident, with delayed egress and secured perimeter. LPA was provided the gate code during today's visit.

The facility is a single story structure with (1) main house and (2) additional guest houses on the property. The buildings sit behind a locked electric gate. The guest house to the right will be occupied by the live in caregiver(s). The second guest house (towards the left upon entry to the property could potentially be used for (2) residents, however the approved capacity is (6). The applicant will obtain clarification in regards to the fire clearance and getting the comments updated to ensure placement in the second building is approved. The home is equipped with video cameras on the exterior areas of the property as well as solar panels.
The main house consists of a garage with (2) storage rooms), backyard, kitchen (5) bedrooms and (2.5) bathrooms. The facility was observed to have the required postings, and operable smoke and carbon monoxide detectors, and (4) fully charged fire extinguishers.

The facility is equipped with no skid mats, grab bars and shower chairs. The resident bedrooms were observed to have adequate lighting, clean linen, chest of drawers, and chairs. The medications will be locked inside a cabinet inside the hallway, as well as the staff and resident files. There are no pools or bodies of water or known guns or ammunition on the premises. The applicant completed successfully COMP III orientation on 10/16/24. The facility was evaluated in accordance with the California Code of Regulation (CCR), Title 22 Chapter 6, Division 8. Based on the observations and evaluation of the facility this date, the facility’s ready for licensure. An exit interview was conducted and a copy of this report was provided to Yusuf Karatas, Applicant.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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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