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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604843
Report Date: 11/06/2024
Date Signed: 11/06/2024 09:59:38 PM

Document Has Been Signed on 11/06/2024 09:59 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GOLDEN HEART HOME CAREFACILITY NUMBER:
374604843
ADMINISTRATOR/
DIRECTOR:
VENTURA, ABIGAILFACILITY TYPE:
740
ADDRESS:1744 HERMES STREETTELEPHONE:
(858) 294-3011
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY: 6CENSUS: DATE:
11/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Applicant, Abigail VenturaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an announced Pre-Licensing with the Component III inspection, and to observe the facility’s physical plant for complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted at the front entrance by the Applicant, Abigail Ventura, and was granted entry after identifying herself and disclosing the purpose of their visit. The facility’s licensee is under the name The Golden Investment Adventure, LLC.

The fire clearance was approved on 6/20/2024 and reflected that the facility was approved for a residential facility for the elderly 60 and over. Maximum capacity six (6) residents all of which may be non-ambulatory. The facility sketch was consistent with the current layout of the facility.

During today’s visit, LPA accompanied by Applicant, Ventura, conducted an overall inspection of the internal and external areas of the facility. There are four (4) bedrooms for residents to use. Two (2) bedrooms are single occupancy and two (2) are double occupancy. There are two full-size bathrooms equipped with grab bars and non-skid mats or stickers. The facility was clean, sanitary, and in good repair. The toilets, sinks, and showers were in working order. Each window had a screen which was in good condition.

The facility’s ambient internal temperature was comfortable. The wall thermometer was not indicating the current temperature, the applicant stated they were in the process of getting it serviced by the end of the week. Hot water temperature at taps accessible to clients was compliant: the kitchen sink was at 111 degrees.

(continue at LIC809C)
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: GOLDEN HEART HOME CARE
FACILITY NUMBER: 374604843
VISIT DATE: 11/06/2024
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(continue from LIC809)

All outdoor and indoor pathways were free from obstruction and slip hazards. Fire extinguisher (1) was purchased in June 2024. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were present and operational.

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and client activities. The facility has no pools or bodies of water that were observed on the facility premises. Per applicant, no firearms or ammunition are or will be stored on the facility premises.

All toxic substances/poisons, and chemicals were stored in inaccessible areas from clients. No fireplaces, and/or open-faced heaters were observed to be accessible to clients.

The facility has locked areas for storage of sharp objects. The facility kitchen was stocked with appropriate cooking items, and knives were locked in a secure cabinet which is inaccessible to clients. A seven (7) day non-perishable and two (2) day perishable food supply was present.

A designated storage lockable area for medications was observed to be available for use. One (1) first aid kit and a manual was present and readily available for use. A secured designated area for client and staff files was also observed to be available in a locked area. Required licensing postings were observed in visible areas of the facility.

LPA discussed continuing operation requirements, record keeping, reporting requirements, and physical plant compliance with the applicant. The items reviewed were compliant with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code.

The Pre-Licensing and Component III inspection was completed during today’s visit. The applicant was advised that the facility is ready for licensure pending management's final review and approval.

An exit interview was conducted with Applicant, Ventura, to whom a copy of this report along with the licensee Appeal Rights was provided at the conclusion of the visit. The signature below confirms receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
LIC809 (FAS) - (06/04)
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