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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700989
Report Date: 03/04/2021
Date Signed: 03/04/2021 04:11:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:GOLDEN LIVING HOME CAREFACILITY NUMBER:
312700989
ADMINISTRATOR:SORIANO, DANELLE KIM R.FACILITY TYPE:
740
ADDRESS:1415 LONG CREEK WAYTELEPHONE:
(916) 772-6224
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 0DATE:
03/04/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Danelle SorianoTIME COMPLETED:
04:05 PM
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Licensing Program Analyst(LPA) Hiratsuka, contacted the facility via telephone due to COVID-19 and pre-cautionary measures. The purpose of this call is conducting an announced prelicensing visit. LPA spoke to Applicant/Administrator Danelle Soriano. Administrator held the camera to show LPA the facility.

This facility has five resident rooms and one staff room. The staff room is bedroom five and it has a full private bathroom and an exit to the outside. Bedroom three is shared. From the main entrance there is a hallway to the left that leads to an office, one full common bathroom, and two private resident rooms. To the right there is the common area. Past the first hallway on the left is a second hallway that has bedroom three, four, five, full common bathroom, and the laundry room. The kitchen and activity room is in the back of the facility and there is a door leading to the outside. The backyard has a gate on both sides of the facility and a locked storage shed on each side. Signs were posted throughout the house for hand washing. The front door and facility has required signs posted. There are locked cabinets for medications, cleaners, and sharp knives.


Component III orientation was conducted.

This facility meets all regulations. LPA is going to submit this report to the application specialist for final review.

LPA is going to email a copy of this report to Administrator and Administrator is to sign, and email a copy back to LPA.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
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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