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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397001613
Report Date: 01/07/2025
Date Signed: 01/07/2025 03:13:56 PM

Document Has Been Signed on 01/07/2025 03:13 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 ACRES HOME AND CARE IIFACILITY NUMBER:
397001613
ADMINISTRATOR/
DIRECTOR:		MARIVIC TEANO-CHUAFACILITY TYPE:
735
ADDRESS:2002 E. HARDING WAYTELEPHONE:
(209) 943-5420
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 15CENSUS: 15DATE:
01/07/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Catherine CalairoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 1/7/2025 at 2:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding a follow up health and safety check for resident1 (R1) and R2. LPA met with lead caregiver Catherine Calairo and explained the purpose of the visit. LPA contacted Administrator Marivic Teano-Chua and explained the purpose of the visit. Administrator gave permission for lead caregiver to sign in her absence.

R1 and R2 moved into Golden Acres Home and Care II from a previous licensed facility due to a closure. R1 was admitted 9/5/24 and is currently residing in a skilled nursing facility due to a recent fall during an outing. R2 was admitted on 8/30/24. LPA conducted brief interview with R1, Administrator, and lead caregiver during today's visit. LPA observed both R1 and R2's personal belongings in place as well as necessary medication on hand and available. LPA observed R1 and R2's rooms to contain necessary furniture and furnishings. LPA also observed facility to maintain adequate food supply and comfortable temperature throughout facility, and no obstructions to emergency exits. All sharp objects and other dangerous items are inaccessible to residents in care.

As a result of today's case management, no citations are issued. An exit interview was conducted with lead caregiver and a copy of this report was provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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