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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602369
Report Date: 03/16/2022
Date Signed: 03/16/2022 05:23:36 PM

Document Has Been Signed on 03/16/2022 05:23 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GOLDEN LIVING HEALTH MANAGEMENT, INC.FACILITY NUMBER:
374602369
ADMINISTRATOR:ROCIO GRANDAFACILITY TYPE:
740
ADDRESS:3223 DUKE STREETTELEPHONE:
(619) 222-1109
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY: 113CENSUS: 78DATE:
03/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Administrator, Rocio GrandaTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced annual required licensing inspection. LPA met with Administrator, Rocio Granda. LPA stated purpose of today’s visit, to verify compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices. This is also in conjunction with a Legal/Non-compliance visit.

The Department conducted an on-site visit to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, LPA interviewed the Administrator and conducted a walk-though of the facility. A debriefing was conducted at the conclusion of the visit.

In addition, LPA discussed the following items with the administrator to ensure compliance: CCR 87705 - Care of Persons with Dementia; CCR 87465 - Incidental Medical & Dental Care; CCR 87468 - Additional Personal Rights of Residents in Privately Operated Facilities; CCR 87463 Reappraisals; and CCR 87211 - Reporting Requirements.

No deficiencies were observed during today’s visit. An exit interview was conducted, and a copy of this report and Licensee Rights (LIC 9058 01/16) were provided to the Administrator via electronic mail. An electronic mail read receipt was requested to be provided upon receipt of the documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022
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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