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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700616
Report Date: 07/25/2022
Date Signed: 07/25/2022 12:32:01 PM

Document Has Been Signed on 07/25/2022 12:32 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:GOLDEN AGE LIVING TURLOCKFACILITY NUMBER:
502700616
ADMINISTRATOR:JACOPETTI, JOSHUA C.FACILITY TYPE:
740
ADDRESS:1259 JOETT DRIVETELEPHONE:
(209) 417-2742
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 6CENSUS: 3DATE:
07/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Kelsy Ramos TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct an annual/required inspection. LPA Lund met with staff and explained the reason for the visit. Licensee Kelsy Ramos arrived a short time later.

LPA and Kelsy Ramos toured the facility. The facility has 4 resident bedrooms, 2 bathrooms, family living room, dining area and kitchen. The fifth bedroom has been designated as the caregiver bedroom. There is a 2- car garage attached in front of home. The resident bedrooms are furnished with required furnishings.

The Facility has an adequate supply of 7-day non-perishable and 2- day perishables stored in the kitchen and pantry. Smoke and carbon monoxide alert systems were hardwired and found operational.
Fire Extinguishers are fully charged and stored by the kitchen and in the hallway. Toxins are locked and stored under kitchen sink.

No deficiencies were observed during today visit. Exit interview conducted with Kelsy Ramos and copy left.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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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