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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317215
Report Date: 09/07/2023
Date Signed: 09/07/2023 03:25:46 PM


Document Has Been Signed on 09/07/2023 03:25 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
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: 24DATE:
09/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Marivic Teanu-ChuaTIME COMPLETED:
03:35 PM
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On 9/7/23 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a case management related to mold remediation. LPA Jensen met with Licensee Marivic Teanu-Chua and explained the purpose of today's visit.

In the afternoon of 9/6/23 LPA Jensen received information via email from the California Public Health Department (CDPH), Healthcare-Associated Infections (HAI) Program recommending the facility hire an Industrial Hygienist who is experienced in mold remediation to oversee the cleanup. The Industrial Hygienist would design the containment needed to prevent exposures to residents and staff using guidelines established by governmental agencies. CDPH has also recommended that the contractor who does the cleanup follow recommendations in the Environmental Protection Agency (EPA) guide Mold Remediation in Schools and Commercial Buildings. the guidelines of the American Conference of Governmental Industrial Hygienists (ACGIH) and the guidelines from the Institute of Inspection, Cleaning and Restoration Certification (IICRC).

LPA Jensen discussed these recommendations with the Licensee and advised the Community Care Licensing Department is giving the directive to follow the guidance issued by CDPH. An email was sent to the Licensee with a link to the American Industrial Hygienists Association (AIHA) where a consultants list can be found. LPA Jensen advised that the mold remediation completion date can be subject to change based on the assessment done by the Industrial Hygienist.

No citations were issued during the course of this visit. An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023
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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