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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507004123
Report Date: 01/17/2025
Date Signed: 01/17/2025 09:26:24 AM

Document Has Been Signed on 01/17/2025 09:26 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GOLDEN AGE IIIFACILITY NUMBER:
507004123
ADMINISTRATOR/
DIRECTOR:		BIANCA PLACINTARFACILITY TYPE:
740
ADDRESS:3101 IRON GATE DR.TELEPHONE:
(209) 408-0428
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 6CENSUS: 6DATE:
01/17/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Marinela Placintar TIME VISIT/
INSPECTION COMPLETED:
09:30 AM
NARRATIVE
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A Non-Compliance Conference (NCC) was conducted on this day, 1/17/2025, by the Sacramento South Regional Office via Microsoft Teams. The purpose of this NCC meeting was to discuss an incident that occurred during an annual visit on 1/06/2025. Present at the meeting were Regional Manager (RM), Stephenie Doub, Licensing Program Manager (LPM), Lisa Rios, Licensing Program Analyst (LPA), Arielle Pascua, and Licensee, Marinela Placintar. The Non-Compliance Conference process was explained during this meeting to include the administrative process.

On 01/06/2025, the department conducted an unannounced visit to this facility and found that the facility power had been shut off at this location. Upon further interview with the Licensee, it was learned that all facilities owned by this Licensee did not any electricity.

Items discussed during the Non-Compliance Conference were:
-Facility Maintenance
-Responsibility to provide care and supervision

The Licensee has agreed to do the following in order to bring the facility into compliance no later than 04/01/2025:
-Ensure that proper care and supervision are provided to all residents at all times.
-Provide copies of all major utility statements to the LPA for the next 3 months.
-Provide the following copies to the LPA by 1/2/24025:
  • -A copy of the facilities bank statements from September 2024-Current
  • -A copy of the facilities gas utility statements from September 2024-Current
  • -A copy of the facilities electric statement from September 2024-Current
  • -A copy of the facilities trash/garbage statement from September 2024-Current
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GOLDEN AGE III
FACILITY NUMBER: 507004123
VISIT DATE: 01/17/2025
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The RO will continue increased monitoring and revisit compliance in 6 months. Completing the non-compliance conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.
In the event that the Department determines that the licensee has violated the law/regulations or is inadequately implementing the approved plans, the Department, in its discretion, may seek formal legal action or other appropriate administrative action.

Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited during this visit. An exit interview was conducted with Licensee, Marinela Placintar, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. In addition, a copy of this report will be sent out certified mail.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
LIC809 (FAS) - (06/04)
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