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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700989
Report Date: 04/25/2023
Date Signed: 04/25/2023 01:49:48 PM


Document Has Been Signed on 04/25/2023 01:49 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:
04/25/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Danelle Kim Soriano, LicenseeTIME COMPLETED:
01:40 PM
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On 04/25/2023 Licensing Program Manager (LPM) Troy Ordonez and Licensing Program Analyst (LPA) Bethany Mirlohi met with Licensee Danelle Kim Soriano, via teleconference to discuss change of ownership of facility.

The licensee agrees to the following:

  1. The licensee for Golden living Home care shall provide written notice to the department and to each resident or his or her legal representative of the licensee's intent to sell the facility at least 30 days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer.
  2. The licensee shall notify in writing, a prospective buyer of the necessity to obtain a license, if the buyer's intent is to continue operating the facility as a residential care facility for the elderly.
  3. The Licensee shall obtain a lease back agreement if the close of the property occurs before buyer has an approved license.
  4. The licensee understands she is still accountable for the facility until the licensure has been approved.
  5. The licensee understands that the buyer and any new employees need to be fingerprint cleared and associated to the current license.

LPA will forward a copy of this report to licensee. Licensee to review report, sign, and return a signed copy to CCL.

Exit interview conducted.

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2023
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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