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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202451
Report Date: 02/05/2025
Date Signed: 02/05/2025 05:16:29 PM

Document Has Been Signed on 02/05/2025 05:16 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:GOLDEN YEARS III RCHE, THEFACILITY NUMBER:
107202451
ADMINISTRATOR/
DIRECTOR:		GALVEZ, MARLENEFACILITY TYPE:
740
ADDRESS:7641 N. MANSIONETTE DRTELEPHONE:
(559) 271-2823
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
02/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Administrator - Carlo SantosTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On 02/05/2025, Licensing Program Analyst (LPA) M Vega arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Staff 1 (S1). Facility Manager Noimi Bacani, Michael Bacani and Administrator Carlo Santos was notified of Licensing visit over the phone and was able to attend the visit. LPA toured facility with Administrator Carlo Santos.

The facility was observed to be at a comfortable temperature, of 74 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. LPA observed most residents in their rooms resting. Department phone number and infection prevention information signs were posted in facility. Restroom water temperature was tested and recorded reading of 112.6 degrees F.

LPA toured facility with Administrator outside. LPA observed the back yard, fenced and in good repair. Outdoor seating area was observed in good repair and available to residents.

Fire extinguisher was observed with a service date of 03/22/2024. All 6 resident bedrooms were observed to be with comfortable temperature. Medications observed to be locked in cabinets in dining area. Cleaning supplies were observed to be in a locked and inaccessible to residents. Kitchen LPA observed the required 7 day supply of non-perishable food and 2 day supply of fresh perishables to be properly stored. An emergency disaster supply was observed.

Continued on LIC 809C
Brenda ChanTELEPHONE: (650) 272-4781
Martin VegaTELEPHONE: 559-243-8080
DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: GOLDEN YEARS III RCHE, THE
FACILITY NUMBER: 107202451
VISIT DATE: 02/05/2025
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LPA reviewed Staff and Resident files. Resident files observed to have updated information.

No deficiencies were observed and cited. Exit interview conducted.
Report was signed and copy of this report was provided for facility records.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 272-4781
LICENSING EVALUATOR NAME: Martin VegaTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC809 (FAS) - (06/04)
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