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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604841
Report Date: 03/10/2025
Date Signed: 03/10/2025 11:13:32 AM

Document Has Been Signed on 03/10/2025 11:13 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GREAT GOLDEN SENIOR LIVINGFACILITY NUMBER:
374604841
ADMINISTRATOR/
DIRECTOR:
DORVILUS, ROSEFACILITY TYPE:
740
ADDRESS:496 HIGHTREE PLTELEPHONE:
(619) 394-9731
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 6CENSUS: 0DATE:
03/10/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Rose Dorvilus TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Ramon Serrano, conducted an announced Pre-Licensing inspection. LPA met with Licensee Rose Dorvilus and we discussed the purpose of the visit.

LPA conducted a tour of the facility, both inside and outside. Their are no bodies of water on the premises. Each room intended for resident use had the appropriate furniture, bedding and appropriate lighting. The smoke and carbon monoxide alarms were present. Toilets intended for resident use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, curtains and paint throughout the rooms and the facility, were observed in good condition. Licensee stated there are no firearms stored on the premises.

Hot water temperature and facility ambient temperature were both at compliant readings. The facility was observed to be clean and kempt with no strong malodors. The main kitchen refrigerator and freezer was observed to be clean and operational, with an ample amount of food to meet resident needs. Cleaning solutions were also properly secured in the garage storage areas.

The Component III portion of the application process was completed with Licensee Rose Dorvilus on today's date as well.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted with Rose Dorvilus and a copy of this report along with Licensee Rights was provided to Rose Dorvilus whose signature below verifies receipt of these.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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