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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002889
Report Date: 11/15/2024
Date Signed: 11/15/2024 04:32:20 PM

Document Has Been Signed on 11/15/2024 04:32 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GOLDEN CREST CARE CENTERFACILITY NUMBER:
347002889
ADMINISTRATOR/
DIRECTOR:		VICTOR BURACHEKFACILITY TYPE:
740
ADDRESS:8120 PATTON AVENUETELEPHONE:
(916) 725-6766
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Victor Burachek, Administrator TIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Administrator, Victor Burachek, and Natalia Burachek, culinary staff, and explained purpose of inspection. LPA observed (4) residents watching television in the common area and (2) residents in their rooms. The facility is licensed for (5) non-ambulatory and (1) ambulatory residents and has a hospice waiver for (1). Currently there are (6) residents and no residents are under hospice care.

LPA and the Administrator toured the interior and exterior of the facility including the common areas, (6) resident bedrooms, (2) shower rooms, (4) resident bathrooms, kitchen, office, laundry area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable supply of food, including fresh produce, and 7+day non-perishable supply of food. Toxins and medications were locked in the kitchen. The lock on the sharps drawer needs to be replaced as it recently broke. Sharps were immediately removed and secured with the medications. LPA observed sufficient linens/blankets/incontinent supplies/PPE. Smoke/monoxide alarms work and the fire extinguisher was last serviced 12/13/23 and will be serviced again by 12/13/24. Hot water temperature measured 118*F in a resident bathroom. There is an unlocked exit in the backyard and plenty of outdoor/indoor space for activities. There are no pools.

LPA reviewed (3) of (6) resident files- files were organized and contain current documents. Medications were reviewed for (2) residents and no discrepancies were noted. Documentation is maintained. Residents were not available for an interview. Both staff have First Aid/CPR certifications on file. RCFE Administrator certificate #7002750740 is pending. Department website shows the renewal paperwork was received 8/15/23. Administrator and LPA to follow up next week.

There are no deficiencies issued on this report. Exit interview. Copy of report provided to Administrator.
Maribeth SentyTELEPHONE: (916) 263-4813
Sabrina CalzadaTELEPHONE: (510) 829-2133
DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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