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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005174
Report Date: 04/26/2024
Date Signed: 04/26/2024 09:20:11 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/26/2024 09:20 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:GOLDEN AGE VFACILITY NUMBER:
507005174
ADMINISTRATOR:OANCEA, TRAIANFACILITY TYPE:
740
ADDRESS:3301 SHARON AVENUETELEPHONE:
(209) 495-2504
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:6CENSUS: 0DATE:
04/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marinela PlacintarTIME COMPLETED:
09:30 AM
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On 04/26/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. Upon arrival, LPA observed two construction workers at the facility who stated that they are currently working on flooring at the facility. LPA called Licensee, Marinela Placintar and notified her of CCL's arrival.
It was learned that the facility does not have any residents in care at this time. LPA asked to walk around the facility to ensure no residents were in care.
LPA observed flooring that was currently being installed throughout the whole facility at this time with no residents in care.
Licensee Placintar stated that she would notify LPA when construction would be done and would start accepting residents.
Licensee Placintar states that the floor may take a couple of weeks.

No deficiencies observed during this visit.

Exit interview and a copy of this report was provided to Licensee Placintar.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2024
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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