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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700989
Report Date: 04/06/2023
Date Signed: 04/06/2023 01:26:12 PM


Document Has Been Signed on 04/06/2023 01:26 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
SACRAMENTO NORTH ASC, 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: 3DATE:
04/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Delei Soriano, Caregiver TIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct annual inspection. LPA met with Delei Soriano during today's inspection, administrator was unable to come to facility.
LPA toured facility with caregiver to ensure health and safety of residents in care. LPA toured 4 resident rooms, 1 staff room, 2 bathrooms, kitchen, common living spaces, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. There has been no positive COVID cases at the facility, but they sufficient amount of PPE. LPA toured the backyard and all exits are accessible and unlocked. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Staff were unable to provide LPA with required files. LPA will return on a later date to complete annual inspection.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
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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