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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700774
Report Date: 01/10/2022
Date Signed: 01/10/2022 11:20:05 AM

Document Has Been Signed on 01/10/2022 11:20 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 AGE SENIOR DAY CARE SERVICESFACILITY NUMBER:
392700774
ADMINISTRATOR:TANG, RENEEFACILITY TYPE:
775
ADDRESS:920 N YOSEMITE STTELEPHONE:
(209) 546-0715
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY: 48CENSUS: 35DATE:
01/10/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Senaida CasillasTIME COMPLETED:
11:32 AM
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On 1/10/22 at 9:59am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with Senaida Casillas, facility supervisor and explained the purpose of the visit. Administrator Renee Tang was notified of LPAs visit by phone and was explained the purpose of the visit. Administrator gave permission for facility supervisor to accommodate LPA and sign in her absence.

LPA Bilger inspected the physical plant including but not limited to the kitchen area, classroom area; bathrooms, common areas, and outside patio of the facility to ensure compliance with Title 22 regulations. Facility is a 48 capacity adult day program with a current census of 35. Facility has one large area designated for client use and program activities. Currently all programs are done remotely. Clients are not physically receiving services in the facility.Tables in the classroom were observed to be socially distanced. LPA also conducted the infection control domain tool.
The facility has an approved COVID Mitigation plan LIC 808 form in place.The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use.

Water temperature reads 105.2*F in the bathroom and room temperature reads 72*F. Classroom and bathrooms were sanitary. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 3/23/2021. Facility has 30-day supply of PPE.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Senaida Casillas and a copy of this report was held with Senaida.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2022
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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