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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602369
Report Date: 01/19/2022
Date Signed: 01/19/2022 03:44:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GOLDEN LIVING HEALTH MANAGEMENT, INC.FACILITY NUMBER:
374602369
ADMINISTRATOR:ROCIO GRANDAFACILITY TYPE:
740
ADDRESS:3223 DUKE STREETTELEPHONE:
(619) 222-1109
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:113CENSUS: 78DATE:
01/19/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Diana RodriguezTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted a technical assistance visit. LPA identified herself and discussed the purpose of the visit with Wellness Director Diana Rodriguez.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, LPA interviewed the Wellness Director and conducted a walk-though of the facility. A debriefing was conducted at the conclusion of the visit.

During today's visit, no deficiencies were cited. An exit interview was conducted with Wellness Director Diana Rodriguez. A copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to Administrator Rocio Granda via electronic mail. An electronic receipt of confirmation was requested upon receipt of the documents.
SUPERVISOR'S NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
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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