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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317215
Report Date: 09/01/2023
Date Signed: 09/05/2023 10:29:09 AM


Document Has Been Signed on 09/05/2023 10:29 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



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:
09/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marivic Teanu-ChuaTIME COMPLETED:
12:30 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
On 9/1/23 at approximately 10am Licensing Program Analyst Maja Jensen arrived at facility to conduct a Plan of Correction case management. LPA Jensen with Administrator Maricel Yapo and explained the purpose of today's visit. LPA Jensen was later joined by Licensee and LPA Jensen explained the purpose of the visit to the Licensee as well.

LPA Jensen observed the front entrance, front foyer and front reception area to sectioned off by means of floor to ceiling tarps. LPA Jensen toured the sectioned off area and observed the ceiling tiles to be removed. LPA Jensen interviewed Administrator Maricel Yapo who confirmed that mold remediation was done in this are and they are waiting on post remediation air quality testing results which should be complete within 2 days.

LPA Jensen received the following timeline regarding Plan of Correction completion:
Schedule of Work and Completion Date:
A. Front/ Receiving Area - Completion of Work 09/06/2023
B. Back Exit Hallway and Rm. E
Indoor Restore will start demobilization & test on 09/11/2023
Test Results available after 2-3 days - 09/14/2023
If post job test is clear, Contractor will start ceiling and paint work on 09/15/2023
Completion of work - 09/22/2023

Cross reporting has been done to the California Public Health Department and San Joaquin County Health Department.

No citations were issued during the course of this visit. An exit interview was conducted. Due to technical difficulties this report was delayed and sent to the Licensee for electronic signature on 9/5/23.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023
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