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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203439
Report Date: 07/12/2021
Date Signed: 07/12/2021 01:51:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:GOLDEN YEARS II, THEFACILITY NUMBER:
107203439
ADMINISTRATOR:GALVEZ,MARLENEFACILITY TYPE:
740
ADDRESS:9658 N. WINERY AVENUETELEPHONE:
(559) 299-8471
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 5DATE:
07/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Administrator, Carlo SantosTIME COMPLETED:
01:55 PM
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On 07/12/2021 at approximately 12:17 PM, Licensing Program Analyst (LPA) arrived unannounced to conduct an Annual Inspection. LPA introduced self and requested to meet with the Administrator. Administrator was contacted via telephone and would arrive at the facility within 30 minutes. LPA departed the facility and returned at approximately 1:10PM. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. LPA met with Administrator (ADM), Carlo Santos.

Facility tour conducted with ADM. All pathways, entrances and exits were clear from obstructions. No fire clearance issues. LPA observed signs promoting hand-washing, social distancing, and cough/sneeze etiquette. Facility staff observed to be wearing facial coverings. LPA toured the facility kitchen. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. LPA observed a 30 day supply of PPE and cleaning supplies.

Resident bedrooms are single occupant and were stocked with hand sanitizer. Facility bathrooms were stocked with paper towels and liquid soap. Hand-washing signs observed in resident bathrooms. LPA checked residents' medication and observed a 30 day supply. Resident temperature checks are documented daily. Resident records have updated emergency contact information. Facility staff records reviewed for good health and infection control training. Administrator certificate is current.

No deficiencies issued during this inspection.

Exit interview conducted. A copy of this report will be provided to ADM via email and an electronic read receipt confirms receiving this document. Facility Representative signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
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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