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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507004123
Report Date: 03/20/2025
Date Signed: 03/20/2025 03:15:45 PM

Document Has Been Signed on 03/20/2025 03:15 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
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: 4DATE:
03/20/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Marinela Placintar TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 03/20/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an case management. LPA met with Licensee, Marinela Placintar and explained the purpose of this visit. The purpose of this visit was to follow up on the documentation that was requested by the department during a Non-Compliance meeting on 1/17/2025.

Current census was 4. A brief interview with Licensee Placintar was conducted.

On 1/17/2025, a Non-Compliance meeting was held with the Adult and Senior Sacramento South Regional Office and Licensee, Marinela Placintar. It was agreed during this meeting that Licensee Marinela Placintar would supply the Regional Office with the following documentation which was due by 1/24/2025:

· 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
In addition, a copy of all major utility statements are due at the end of each month for January 2025-March 2025.

A subsequent email as sent to Licensee, Marinela Placintar and Facility Designated Administrator (FDA), Bianca Placintar on 02/5/2025 as a reminder that documentation requested has not been received.

As of the date of the visit, 03/20/2025, the Regional Office has not received any documentation from the Licensee or Administrator. It was stated by the Licensee that she miss understood what was requested and will send documentation by the end of the day. LPA asked that Licensee Placintar to provide the documentation by Friday, 03/21/2025 end of business day 5:00pm. LPA reminded Licensee that failure to provide documentation by due date will result in civil penalties. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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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