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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
286804071
Report Date:
09/06/2024
Date Signed:
09/06/2024 10:00:32 AM
Document Has Been Signed on
09/06/2024 10:00 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
GOLDEN HEARTS SENIOR CARE, LLC
FACILITY NUMBER:
286804071
ADMINISTRATOR:
MANALO, EDWARDSON
FACILITY TYPE:
740
ADDRESS:
1630 ARCADIA COURT
TELEPHONE:
(415) 770-4285
CITY:
NAPA
STATE:
CA
ZIP CODE:
94558
CAPACITY:
6
CENSUS:
5
DATE:
09/06/2024
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
09:29 AM
MET WITH:
Edwardson Manalo
TIME COMPLETED:
10:00 AM
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Licensing Program Analyst Leibert arrived unannounced for the purpose of verifying proof of correction from a deficiency issued on 08/13/2024. LPA met with the Administrator and reviewed the activity logs. LPA has verified that the activity logs have been completed and the facility has cleared the deficiency.
SUPERVISOR'S NAME:
Carla Martinez
TELEPHONE:
(707) 588-5059
LICENSING EVALUATOR NAME:
David Leibert
TELEPHONE:
(707) 588-5086
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2024
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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