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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701254
Report Date: 05/18/2023
Date Signed: 05/18/2023 11:57:22 AM

Document Has Been Signed on 05/18/2023 11:57 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:
05/18/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Prasheila Singh, LicenseeTIME COMPLETED:
12:15 PM
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Announced case management pre-licensing continuation visit was conducted by Program Licensing Analysts (LPAs) Kimberly Viarella and Kesha Lewis to this facility on 05/18/23. LPAs were met by be the Licensee, Prasheila Singh and a brief interview followed. This was not a change of ownership and there were no residents in care at this time.

LPAs did a walk through of the facility verifying that the following corrections from the previous visit had been completed. Knives and other sharps were stored in a locked case in a kitchen drawer and inaccessible to future residents, 4 screens were replaced and the small hole in the window of the master bedroom had been repaired. The broken fence had been replaced.

Comp 2 was completed with Licensee.

Facility passed the pre-licensing inspection. California Applications Bureau will be notified within 24 hours.

Exit interview.
Report provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2023
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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