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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317215
Report Date: 07/09/2024
Date Signed: 07/09/2024 01:04:40 PM


Document Has Been Signed on 07/09/2024 01:04 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 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:
07/09/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marivic Teano-ChuaTIME COMPLETED:
10:30 AM
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Announced office informal meeting conducted on 07/09/2024 by Licensing Program Manager (LPM) Liza King and Licensing Program Analyst (LPA) Charlie Yang with the facility designated Administrator Marivic Teano-Chua.
Also present in this informal meeting were the following individuals:
  • Jennifer Conway-Brandt-San Joaquin County Behavioral Health Services
  • Sherri Helsby-San Joaquin County Behavioral Health Services
  • Danielle Wiseman-San Joaquin County Behavioral Health Services


The purpose of this informal meeting was to review the last calendar year since this facility had been placed on more increased monitoring and quarterly visits. The initial informal meeting was conducted on 08/02/2023 due to issues with the roof being in need of repair and the presence of mold throughout this facility.
Since that time, this Department has conducted a total of (9) unannounced visits out to this facility to make sure that the physical plant, resident care and supervision, and facility staffing were sufficient and in compliance at all times.
At the time of this informal meeting, there weren't additional deficiencies observed or cited within the last year in relation to the roof and mold issues. The only deficiencies that were observed and cited were noted on an annual visit conducted on 05/09/2024. These deficiencies consisted of lack of annual staff training hours and incomplete facility resident files.
As a result, this facility will be removed from the requirements of the informal for increased monitoring and quarterly visits.
There were no deficiencies observed or cited during today's informal meeting.

Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
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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