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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701254
Report Date: 04/13/2023
Date Signed: 05/18/2023 07:36:52 AM

Document Has Been Signed on 05/18/2023 07:36 AM - 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:GOLDEN PRIDE SERVICES CARE-NIGHTINGALEFACILITY NUMBER:
502701254
ADMINISTRATOR:PENNY, TYRONEFACILITY TYPE:
735
ADDRESS:3221 NIGHTINGALE DRTELEPHONE:
(209) 380-6191
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 4CENSUS: 0DATE:
04/13/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Prasheila SinghTIME COMPLETED:
01:30 PM
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Announced pre-licensing inspection was conducted by Licensing Program Analysts, (LPAs) Kimberly Viarella and Maja Jensen to this facility on 04/13/23. LPAs were met by the Licensee, Prashelia Singh and a brief interview followed. This was not a change of ownership and there were no residents in care at the time of the visit.

The fire extinguisher was purchased on 12/16/22 at Home Depot and the receipt was attached. Enough smoke and carbon monoxide detectors were present to be in compliance. The hot water was measured to ensure that it was between 105 and 120 degrees.

LPAs inspected the dining room, living room, 3 bedrooms, 2 bathrooms, linen closet, utility closet, and garage. The also reviewed the exterior of the facility, fencing, and shed. There were no bodies of water present.

The facility did not pass the pre-licensing inspection today for the following reasons:
LPAs observed knives and other sharps in an unlocked kitchen drawer accessible to future residents in care. LPAs observed chemicals stored in an unlocked cabinet under the kitchen sink and accessible to future residents in care. LPAs observed 4 screens that had holes and / or bends in their frames and a small hole in the window of the master bedroom which could allow insects into the facility and would pose a risk to residents in care. LPAs observed the wooden fence was broken and in disrepair which also would pose a risk to residents in care.

Licensee stated that she will have the repairs completed by 05/13/23.

Exit interview with Licensee. Copy of this report provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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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