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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317215
Report Date: 05/09/2024
Date Signed: 05/14/2024 09:35:32 AM


Document Has Been Signed on 05/14/2024 09:35 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:GOLDEN ACRES HOME AND CAREFACILITY NUMBER:
390317215
ADMINISTRATOR:MARICEL YAPOFACILITY TYPE:
740
ADDRESS:1101 CALIFORNIA STREETTELEPHONE:
(209) 838-3405
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY:26CENSUS: 26DATE:
05/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maricel Yapo TeskeTIME COMPLETED:
03:00 PM
NARRATIVE
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Unannounced case management visit made out to this facility on 05/09/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated co-Administrator, Maricel Yapo Teske, who was requested by this LPA to go ahead and contact the facility designated Administrator, Marivic Teano-Chua, to let her know that CCL was present at this time.
The facility designated Administrator Marivic Teano-Chua was unable to attend today's case management visit which was confirmed by this LPA via telephone conversation.
A brief interview was conducted with the facility designated co-Administrator at this time.
Current census was 26 residents.
The purpose of this visit was to review the mold remediation that was conducted and completed by this facility, and it's representative, as recommended by the California Department of Public Health (CDPH).
Tour of this facility was conducted.
The following concerns were reviewed at the time of this case management visit:
  • Areas of concern were the hallway leading into the resident rooms.
  • Rooms D and E were of concern and had work completed since leaks were still present that needed to be addressed at this time to prevent further issues.
  • The television room was also toured since the ceiling was removed and replaced.
  • The dining area was also a cause for concern with possible leaking through the roof and ceiling.
  • It was learned that additional renovations were in the works such as the roof since it was the main cause for the mold due to leaks and moisture build up.


The areas that required updates and replacement were toured. It was observed that these items had been completed and were still maintained in compliance at this time.

There were no additional deficiencies observed or cited at this time. Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2024
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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