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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209150
Report Date: 06/03/2021
Date Signed: 06/03/2021 03:08:01 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 RESIDENTIAL CARE HOME, THEFACILITY NUMBER:
207209150
ADMINISTRATOR:LUARES, BERNARDINOFACILITY TYPE:
740
ADDRESS:160 S 13TH STREETTELEPHONE:
(707) 235-2717
CITY:CHOWCHILLASTATE: CAZIP CODE:
93610
CAPACITY:41CENSUS: 36DATE:
06/03/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Bernardino Luares, Elizabeth Luares-PrasadTIME COMPLETED:
12:00 PM
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On this date, Licensing Program Analyst(LPA) D. Ayers arrived at the facility for an announced Pre-licensing Inspection. LPA met with Licensee Elizabeth Luares-Prasad and Administrator Bernardino Luares.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. The facility was adequately furnished, well-lit, and at a comfortable temperature. The facility had a hard-wired sprinkler system installed. LPA toured resident bedrooms and bathrooms and observed bedrooms to have required minimum furnishings. Bathrooms have secure grab bars and non-skid mats. Outdoor area was free from hazards and had enough seating for all residents.

Licensee and Administrator completed Component III Orientation. No deficiencies were cited during the inspection. A copy of this report was provided to the licensee via email.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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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