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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002889
Report Date: 11/23/2022
Date Signed: 11/23/2022 12:47:01 PM


Document Has Been Signed on 11/23/2022 12:47 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:GOLDEN CREST CARE CENTERFACILITY NUMBER:
347002889
ADMINISTRATOR:VICTOR BURACHEKFACILITY TYPE:
740
ADDRESS:8120 PATTON AVENUETELEPHONE:
(916) 725-6766
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 6DATE:
11/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Natalia Burachek, caregiver TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Natalia Burachek, caregiver and explained purpose of inspection. LPA met with Administrator, Victor Burachek, who arrived with (1) resident after a medical appointment. LPA observed (1) resident in the common area and (4) residents in their individual resident rooms. Currently there are (0) residents on hospice. The facility is licensed for (5) non-ambulatory residents, (1) ambulatory and has a hospice waiver for (1). Residents are placed appropriately in each room. Prior to initiating today's inspection, LPA completed required COVID-19 protocols, and was screened per Covid-19 precautionary measures upon entering the facility. LPA wore a surgical mask.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (6) resident bedrooms with 1/2 bathroom each, (2) separate full bathrooms, kitchen, staff room and locked laundry area. There is one side of the house not used by residents. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and 20- second hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked toxins and medications in the kitchen. LPA observed unlocks sharps- there are currently no residents with Dementia- Advisory Note is being issued. LPA observed the inside temperature to be 73*F. Fire extinguisher was last serviced 11/23/22- a service company came out during today's inspection to re-service the extinguisher that was prepaid, but the company missed the annual inspection due to staffing issues. Discussed vaccination status of residents/staff, eligibility for boosters and visitation protocols. Administrator indicated he is trying to schedule an on-site flu clinic later this month. LPA observed multiple Covid posters throughout as well as other required postings. LPA observed (1) unlocked gate from the inside back patio. There are no pools or bodies of water. LPA reviewed (1) resident file which was organized..

LPA requested an updated copy of LIC500, LIC308 and current liability insurance be provided by 11/30/22.
There are no deficiencies issued; however, an Advisory Note is being issued.
Exit interview with Administrator. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2022
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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