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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002746
Report Date: 12/17/2020
Date Signed: 12/17/2020 03:57:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:GOLDEN ANGELS CAREFACILITY NUMBER:
455002746
ADMINISTRATOR:ANDRADA, RONALD D.FACILITY TYPE:
740
ADDRESS:3747 LOUSTALOT WAYTELEPHONE:
(530) 222-2912
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:6CENSUS: 4DATE:
12/17/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ronald Andrada; LicenseeTIME COMPLETED:
04:00 PM
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On 12/17/2020 at 3PM, Licensing Program Analyst (LPA) Cheng conducted a Prelicensing virtual visit via WebEx and met with Licensee Ronald Andrada. LPA explained reason for visit. Visit was made via WebEx in compliance with the departments procedures regarding COVID-19. LPA toured the facility inside and out including but not limited to facility kitchen, dining room, living room, bathrooms, great room, outside areas, and client rooms. Outside area is free of obstruction and bodies of water. All bathrooms are equipped with hygiene products and paper towels. Facility has a 7-day non-perishable and 2-day perishable supply of food. Outside area is free of obstruction and bodies of water. Medications are stored in locked medication cart in the staff area. Hot water temperature in the kitchen faucet measured at 119 degrees Fahrenheit.

Smoke and carbon monoxide detectors were observed as operational. Fire extinguisher were observed as full. First aid kit was observed to be complete. Fire drill was conducted on 12/2020.

All resident rooms are fully furnished and facility has sufficient activities available for clients.

LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAB. Additional requirements may still be required. COMP III completed at the end of the visit.

Exit interview conducted. Two copies of report were given and LPA requested for a signed copy.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Pheej ChengTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2020
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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