Wolden Family Home #4

Type of visit: Required - 1 Year

On 09/30/2026 at 1:29 PM, Licensing Program Analyst (LPA) Hou Vang and LPA B. Miranda conducted an unannounced One-Year Annual Required inspection visit. LPAs arrived, introduced selves, stated purpose of visit, and were granted entry by Janette Avila, Direct Support Professional (DSP). Current census 3. Residents were currently at Day Program. Janette stated there are 8 staff in total currently. Janette contacted Administrator Designee Jeff Wolden who arrived shortly after. LPAs met with Jeff and conducted Annual Inspection with Jeff. Temperature of facility was set to 74 F. LPAs observed that all bedrooms had required furnishings. Resident bathrooms were clean. Bathroom fixtures were observed to be operational. LPAs observed clean linens in bedrooms and closet meeting regulation requirements. Water temperature measured at 113.5 F. LPA toured kitchen with DSP Janette. Knives were stored in a locked drawer. Eating wares sufficient for number of residents as required by regulation. Facility observed to have a 2-day supply of perishable food and a 7-day supply of non-perishable food available for residents. All common areas were observed to be properly furnished and well lit. Medications observed to be locked and secured in a centrally stored cabinet. All medications were observed to have original labels and to be administered as prescribed. All chemicals and cleaning supplies were observed to be locked and secured in a cabinet and closet. Fire extinguisher observed with a service date of 11/10/26. Smoke detectors and carbon monoxide detectors observed operational at time of inspection. Last disaster drill was conducted on 8/3/26. First Aid kit is on site and complete. LPA toured outdoors area of facility. LPAs observed clean back yard. No obstructions on the fire exits. Staff and resident files reviewed by LPAs. Required facility documents and files reviewed by LPAs. Infection Control Plan is not on site. Jeff will submit a updated copy to the Department. Exit interview was conducted. A copy of the signed LIC809 was provided to Jeff.the state’s words, verbatim · CDSS document, Sep 30, 2026

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 09/23/25, Licensing Program Analyst, LPA L. Salazar arrived at the facility unannounced to conduct the required annual inspection. LPA was greeted by Staff S1, stated the purpose of the visit and was allowed entry into the facility. S1 contacted Administrator, Renee Arreguin Rodriguez who arrived to the facility shortly after LPAs arrival. Administrator Certificate #7033849740 Exp. 02/20/27. LPA toured the facility inside and out. LPA observed 1 resident in care at the time of visit. 3 residents were attending day program. Facility is a 4 bedroom / 2 bathroom house. Resident bedrooms were observed to have the required furnishings and are free from odor and passageway obstruction/fire hazards. Bathrooms were observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 113 degrees F. Required postings were observed. Cleaning supplies were observed to be locked in the laundry room. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Carbon monoxide detector was observed. Fire Extinguisher was observed with a service date of 08/14/25. First aid kit was observed to contain all required items. LPA reviewed resident and staff files and observed the files to have the required documents and training. Medications were observed to be locked in a closet located at the entry of the facility. Quarterly Emergency Disaster Drill logs were observed for staff. LPA is requesting the following documents be submitted to the Fresno CCL office by 10/06/25: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A), Surety Bond. An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.the state’s words, verbatim · CDSS document, Sep 23, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) L. Salazar arrived at the facility for a scheduled Pre-licensing visit. LPA was greeted by Administrator Kyle Wolden and House Manager Courtney Lopez and allowed entry into the facility. LPA toured the facility inside and outside. The facility was observed to be clean, free from clutter and was odor free. LPA observed 3 out of 3 residents present at the time of inspection. The common area rooms were observed to have adequate furnishings, window coverings and lighting. All resident bedrooms were observed to be private and have the required furniture, to include beds with good mattresses, night stand, chair and personal lighting. LPA observed an adequate supply of extra bed linens, towels and personal hygiene/ grooming items. Bathrooms were observed to be properly equipped with trash cans. Hot water temperature was observed to be 108.6 degrees F. Medications are locked in a closet in the living room. Cleaning supplies are stored in a locked cabinet in the activity. First aid kit contains all the required items. Fire extinguisher is present and was serviced in November 28, 2023. Smoke detectors and carbon monoxide were operating properly. Smoke detectors and carbon monoxide were operating properly. Outside of the facility toured. Exits open free of obstruction. Gate is self-latching. No outside hazards were observed. Component III conducted during pre-licensing inspection. Pre-Licensing is complete. Applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.the state’s words, verbatim · CDSS document, Aug 29, 2024

Type of visit: Office

*************Amended Report************** Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 4 Census (if any clients in care): 3 COMP II Participants: Kyle Wolden, Applicant Cheryl Wolden, Applicant/Administrator Interview Method: Telephone interview On August 8, 2024 at 8:00AM, Applicants and Administrator participated in COMP II. Identification of the Applicants and Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicants and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. During COMP II, CAB analyst confirmed Applicants and Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicants and Administrator. Report sent via email and request to return sign copy to CAB by end of business day.the state’s words, verbatim · CDSS document, Aug 28, 2024