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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700989
Report Date: 08/23/2023
Date Signed: 08/23/2023 03:53:43 PM


Document Has Been Signed on 08/23/2023 03:53 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:
08/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Lita Salva and Primo SalvaTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct a case management visit. LPA met with Primo and Lita Salva during today's inspection.

LPA arrived to gather information concerning possible change of ownership. LPA spoke to Licensee/Administrator Danelle Soriano over the phone and confirmed she is still the administrator and licensee. Lita and Primo Salva have bought the home but there is a lease back to Danelle. Lita and Primo Salva are in the process of submitting a new licensee.

No deficiencies cited during today's visit.

Exit interview.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023
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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