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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200996
Report Date: 09/03/2020
Date Signed: 09/03/2020 02:52:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:GOLDEN HOME RCFEFACILITY NUMBER:
079200996
ADMINISTRATOR:MENDOZA, LIWAYWAYFACILITY TYPE:
740
ADDRESS:4234 GOLDENHILL DR.TELEPHONE:
(925) 378-9906
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:6CENSUS: 0DATE:
09/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Liwayway and Dennis Mendoza, AdministratorsTIME COMPLETED:
02:45 PM
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Licensing Program Analyst, (LPA), L. Hall conducted a tele-visit Component III presentation through Facetime on 09/03/2020 starting at 02:00pm. LPA met with Administrators, Liwayway and Dennis Mendoza.

LPA presented Component III power point and discussed the regulations embodied in the power point. LPA observed the participant gained knowledge about running and maintaining the facility in accordance with regulations.

Exit interview conducted with Administrator, Maria Rivera. A copy provided by email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2020
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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