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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 057001380
Report Date: 01/19/2024
Date Signed: 01/19/2024 11:38:44 AM

Document Has Been Signed on 01/19/2024 11:38 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:WATCH-GOLDSTRIKEFACILITY NUMBER:
057001380
ADMINISTRATOR:CHRISTINA GARIBAYFACILITY TYPE:
735
ADDRESS:342 GOLDSTRIKE ROADTELEPHONE:
(209) 754-3773
CITY:SAN ANDREASSTATE: CAZIP CODE:
95249
CAPACITY: 12CENSUS: 6DATE:
01/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Christina Garibay TIME COMPLETED:
11:50 AM
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On 01/19/2024 Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Christina Garibay and explained the purpose of the visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate and expires 10/2025. The facility is licensed for twelve ambulatory or non-ambulatory clients. There are currently 6 client who reside at this facility.

The LPA Martinez toured the facility with Christina Garibay on 01/19/2024 at 11:00 AM.

During today's annual inspection, the facility was sanitary and furnished. Resident bedrooms and bathrooms were sanitary and furnished. Resident common areas and laundry room were sanitary and furnished. The facility had an adequate supply of food, and the kitchen was sanitary. The facility temperature measured at 70 degrees. The last fire/sprinkler inspection was on 01/11/2024. The fire extinguishers are in good repair.

LPA Martinez reviewed three resident files and three staff files. The files were complete, and the first aid kit was complete. LPA Martinez inspected the medication room. All medication was locked. LPA Martinez reviewed one medication administration record, which was maintained. The exterior of the facility was clear of debris, and the facility has an outside shaded patio for client use.

Based on observation, interview, and record review, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time.


An exit interview was conducted, and a copy of this report was given to the facility at the end of the visit.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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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