157201730-2-20-2025-24-AS-MMEA-DE43HN-20250220171612

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157201730
Report Date: 02/20/2025
Date Signed: 02/20/2025 05:16:45 PM

Document Has Been Signed on 02/20/2025 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 VILLA HOME		FACILITY NUMBER:	157201730
ADMINISTRATOR/ DIRECTOR:	SILVA, WENDY		FACILITY TYPE:	740
ADDRESS:	4420 FOXBORO AVE		TELEPHONE:	(661) 564-8574
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93309
CAPACITY: 4	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	02/20/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:40 PM
MET WITH:	Joan Aquino		TIME VISIT/ INSPECTION COMPLETED:	05:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 2/20/25, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Inspection. LPA arrived, introduced self, and allowed entrance by direct care staff. Administrator contacted by telephone and arrived a short time later to conduct inspection with LPA. Currently, there are four (4) residents in care. Residents were arriving home from day program at start of inspection. Facility tour conducted with Administrator. Facility observed to be clean, well lit, and a comfortable temperature. Facility is a 4 bedroom and 2 bathroom home, all residents have private bedrooms. Facility tour began in resident bedrooms, all bedrooms observed to have required furnishings. Resident bathroom toured, bathrooms observed to have grab bars near toilet and grab bars and non-skid mats in tub/shower. LPA measured hot water at 107 degrees in resident bathroom. LPA observed resident bathroom in hallway to have slow draining sink. Living room and dining room have adequate seating available for residents in care. Kitchen toured, LPA observed a 2-day supply of perishable food and a 7-day supply of non-perishable food available. All knives observed to be locked and secured in kitchen drawers. Chemicals are locked and secured under kitchen sink with additional supplies locked and stored in garage. Medication observed to be locked and secured. LPA observed medications to have original labels and to be administered as prescribed. LPA observed smoke detectors and carbon monoxide detectors to be operational during inspection. Last fire drill conducted on 2/10/2025 according to facility records. Fire extinguisher present with a purchase date of 2/23/2024. Continued on 809-C

Alexandria Walton	TELEPHONE: (559) 246-0128
Melinda Medina	TELEPHONE: (559) 410-5914
	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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 VILLA HOME	FACILITY NUMBER: 157201730
	VISIT DATE: 02/20/2025

NARRATIVE

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Outside of facility toured, all exits doors open free of obstruction. LPA observed an old sink/counter cabinet, 2 bedside toilets, 2 night stands, and miscellaneous items in need of removal. LPA observed outside wooden deck in need of repair. LPA observed deck to have uneven walking service, loose boards and broken board during inspection. Facility observed to have a table with umbrella and seating available for residents. Fire exits from back yard to front yard of facility observed to be free of obstruction.

Deficiency cited on the attached 809D

Exit interview conducted with Administrator. Appeal rights provided. A copy of this report provided for facility records.

SUPERVISOR'S NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR NAME: Melinda Medina	TELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 02/20/2025 05:16 PM - It Cannot Be Edited

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 VILLA HOME	FACILITY NUMBER: 157201730
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87303(a)

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors This requirement is not met as evidenced by: LPA observed an old sink/counter cabinet, 2 bedside toilets, 2 night stands, and miscellaneous items in need of removal. LPA observed outside wooden deck in need of repair. LPA observed deck to have uneven walking service, loose boards and broken board during inspection.
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	Administrator to remove items on the side of the house and obtain an estimate for repair or removal of outside wooden deck in the backyard.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Alexandria Walton	TELEPHONE: (559) 246-0128
Melinda Medina	TELEPHONE: (559) 410-5914
	DATE: 02/20/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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