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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700774
Report Date: 01/16/2025
Date Signed: 01/16/2025 03:12:01 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/16/2025 03:12 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/
DIRECTOR:
TANG, RENEEFACILITY TYPE:
775
ADDRESS:920 N YOSEMITE STTELEPHONE:
(209) 546-0715
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY: 48CENSUS: 19DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:57 PM
MET WITH:Karla GuzmanTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection on 1/16/2025. LPA met with explained the purpose of the visit.

Facility is a 48 capacity senior adult activity day program with a current census of 19. The staffing ratio is 7 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 Karla inspected the physical plant including but not limited to the kitchen, bathrooms, large activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. Hot water temperature was measured at 118 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. Medications given at program. (PRN letters needed) LPA reviewed 4 resident and staff files including criminal record clearances. The annual fire permit is expired and needs renewal (Advisory given).

Fire drill was completed 12/2024. All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete.

Exit interview conducted
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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