207209150-8-27-2021-24-AS-SPIY-C8FMYF-20211104100126

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 207209150
Report Date: 08/27/2021
Date Signed: 08/27/2021 04:09:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2021 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20210825081107

FACILITY NAME:	GOLDEN YEARS RESIDENTIAL CARE HOME, THE		FACILITY NUMBER:	207209150
ADMINISTRATOR:	LUARES, BERNARDINO		FACILITY TYPE:	740
ADDRESS:	160 S 13TH STREET		TELEPHONE:	(707) 235-2717
CITY:	CHOWCHILLA	STATE: CA	ZIP CODE:	93610
CAPACITY:	41	CENSUS: 36	DATE:	08/27/2021
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Bernardino Luares, Elizabeth Luares-Prasad		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff did not seek medical attention to resident.
Staff mismanaged residents' medication.
Hazardous chemicals accessible to residents.
Facility has inadequate toiletry and hygiene supplies.
Facility has inadequate supply of food.
Facility is dirty.

INVESTIGATION FINDINGS:

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On this date, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to conduct an Initial 10-day Complaint Inspection. LPA met with Licensee Elizabeth Laures-Prasad and Administrator Bernardino Luares and discussed the puepose of the inspection.

LPA toured facility inside and out. Facility was adequately furnished and lit. LPA observed the facility to be clean and odor free. The facility was recently remodeled with new paint and flooring installed. LPA observed all hazardous materials and cleaning supplies to be secured in locked storage closets. LPA observed sufficient personal hygiene items for residents. Medications were kept in a locked medicine cart in a locked room, and medications appeared to be administered properly. LPA observed a seven day supply of nonperishable food stuffs and a two day supply of perishable food stuffs which were stored properly. LPA toured resident bedrooms and bathrooms. Bedrooms were adequately furnished and lit. Bathrooms were clean, odor free, and had secure grab bars and nonskid mats in showers. Residents stated that the food has been of excellent quality and there had been planety of it.

Based on observations and interviews, the above allegations are Unfounded. No deciciencies were cited during the inspection. Exit interview conducted. A copy of the report was provided to the licensee via email.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

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

LIC9099 (FAS) - (06/04)

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