<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004362
Report Date: 09/24/2021
Date Signed: 09/24/2021 12:28:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:GOLDEN MOMENTS CARE HOME, INC.FACILITY NUMBER:
347004362
ADMINISTRATOR:MAKAYLA WHITEFACILITY TYPE:
740
ADDRESS:2651 ARMSTRONG DR.TELEPHONE:
(916) 979-9828
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:6CENSUS: 6DATE:
09/24/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Makayla White & Denise Walker & Mark GrahamTIME COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Avelina Martinez arrived at this facility unannounced on 09/24/2021 at 11:05 AM to conduct a case management visit. LPA met with Makayla White, Denise Walker, and Mark Graham, and explained the purpose of the visit.

The purpose of the visit today, is in response to a change of ownership application. LPA Martinez reviewed change of owner application with Makayla White and Denise Walker. LPA Martinez was informed Denise Walker is the current licensee, and Mark Graham will take control of the property/facility on projected date October 15, 2021. In addition, Denise Walker will continue to oversee this facility until the change of ownership application has been processed and approved by the Department. Moreover, all current employee will remain working after the change of ownership application has been processed and approved. Additionally, Makayla White will continue to be the administrator of this facility. Furthermore, all residents will remain in the facility after the change of ownership application has been processed and approved.

Mark Graham has completed the administrator certificate requirements in August of 2021. Mark's administrator certificate: 6061146740 status is pending.

LPA Martinez obtained copies of LIC 200, LIC 508, LIC 300, LIC 501, LIC 308 for administer Makayla White.

As a result, of this visit, no deficiencies were cited per Title 22 Regulations.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1