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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209150
Report Date: 05/24/2024
Date Signed: 05/24/2024 05:08:04 PM


Document Has Been Signed on 05/24/2024 05:08 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
SIERRA CASCADE AC/SC, 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: 39DATE:
05/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Administrator, Amber MyersTIME COMPLETED:
10:14 AM
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On 05/24/24, Licensing Program Analyst (LPA) V Gorban conducted unannounced Case Management visit to the facility. LPA introduced self, stated purpose of visit, and allowed entrance by direct care staff.

LPA arrived to amend complaint report to Complaint control number 24-AS-20240207140456 dated 02/07/2024, and complaint findings delivered on 05/09/2024.

LPA met with Administrator to amend complaint report, pick up previous report provided, and deliver updated findings. During this visit the facility returned original report to LPA.

Report signed at time of visit and copies provided for facility records.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024
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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