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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804071
Report Date: 09/09/2024
Date Signed: 09/09/2024 11:51:32 AM


Document Has Been Signed on 09/09/2024 11:51 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, LLCFACILITY NUMBER:
286804071
ADMINISTRATOR:MANALO, EDWARDSONFACILITY TYPE:
740
ADDRESS:1630 ARCADIA COURTTELEPHONE:
(415) 770-4285
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:6CENSUS: DATE:
09/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Edwardson ManaloTIME COMPLETED:
12:00 PM
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At approximately 9:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Edwardson Manalo and explained the purpose of the visit. Administrator certificate is current. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. All required postings were present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. LPA observed several expired food items in the garage. Licensee discarded the items immediately. Facility has the required seven-day non-perishable and two day perishable supply of food. Medication is locked and not accessible. All toxins were secured and not accessible. The facility was observed to be at a comfortable temperature. Water temperature measured within regulation. First aid kit was present. Facility has PPE supplies. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. Facility has been conducting drills every 3 months.

At approximately 10:30AM, LPA reviewed 8 Staff records and 5 resident records. All resident files contained the required documentation. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current.

LPA received evidence of Liability insurance during this visit.

No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.

SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2024
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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