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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005506
Report Date: 08/29/2022
Date Signed: 08/29/2022 12:30:27 PM


Document Has Been Signed on 08/29/2022 12:30 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:GOLDEN YEARS-PROSPECTFACILITY NUMBER:
306005506
ADMINISTRATOR:CHIERICHETTI, MARYFACILITY TYPE:
740
ADDRESS:4232 PROSPECT AVETELEPHONE:
(714) 343-8815
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:6CENSUS: 6DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Mary Chierichetti, AdministratorTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Kathrina Chin conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by Julie Romero, Caregiver. LPA met with Mary Chierichetti, Administrator and explained the nature of the visit.

LPA Chin accompanied by Administrator began the tour of the inside and outside of the facility. LPA observed a check- in station in the main entry of the facility. Facility staff are taking temperatures daily to all visitors, staff and clients and documenting the results. There are six clients in care and there is no active COVID-19 case in the facility. All clients appeared to be clean and well taken care of. LPA observed required department postings, COVID-19 precautionary posting in the facility as well as hand washing sign throughout. LPA observed the emergency disaster and evacuation plan. Restrooms were observed to have a supply of soap as well as hand towels. Restrooms appeared to be clean and all equipment to be functional. LPA inspected client’s bedrooms and they appeared to be clean and sanitary. All bedrooms observed to have required components. The hot water temperature was observed at 117.3 degrees F. LPA inspected the food supply and observed the emergency food and water supply. LPA observed PPE in the kitchen area. Medication is located in kitchen cabinet and LPA observed facility to have a 30 day supply of medication for clients. LPA toured the outside of the facility and there are two patios for shade and outside furniture. The facility has sufficient PPE supplies.

Based on the observation made during today’s vis. it, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022
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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