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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700774
Report Date: 01/10/2024
Date Signed: 01/10/2024 02:44:55 PM

Document Has Been Signed on 01/10/2024 02:44 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 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: 13DATE:
01/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Renee TangTIME COMPLETED:
02:56 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
Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection on 1/10/2024. LPA met with Renee Tang explained the purpose of the visit.

Facility is a 48 capacity senior adult activity day program with a current census of 13. The staffing ratio is 8 to 1. The facility has one large area designated for client use and program activities. 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 in place. LPA and Renee inspected the physical plant including but not limited to the kitchen, bathrooms, large activity room, and outside courtyards. LPA observed two non-working limousines and a generator. LPA observed sufficient furniture and lighting throughout the facility. Hot water temperature was measured at 120 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety. No medications are given at programs. LPA reviewed 5 resident and 5 staff files, including criminal record clearances. Fire drill was completed 6/2023. All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete.

The facility was given an advisory for using storage space in the back area for two non-working limousines. Please remove by 2/10/2024. Exit interview conducted.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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