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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701269
Report Date: 11/09/2023
Date Signed: 11/09/2023 10:51:45 AM

Document Has Been Signed on 11/09/2023 10:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:GOLDEN AGE LIVING TURLOCK 1FACILITY NUMBER:
502701269
ADMINISTRATOR:RAMOS, KELSYFACILITY TYPE:
740
ADDRESS:1259 JOETT DRIVETELEPHONE:
(925) 918-3998
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 6CENSUS: 5DATE:
11/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Dawn Lugo - House ManagerTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced case management visit. LPA met with house manager and explained purpose of visit.

LPA and house manager toured office and garage area. There is no bedroom in the garage and staff is not sleeping there during working shifts. Office area does not have a bed in there, but could use a bed so staff can sleep at night. Normally staff sleep on reclining chair in the living room. LPA did not find any fire violations at the facility.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit.

Exit interview was conducted with house manager and a copy of this report was left at facility.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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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