A Golden Care

Allegation investigated: Facility staff falsified documents

On 04/20/2026 Licensing Program Analyst (LPA) Gorban unannounced visited the facility to commence to complaint investigation. LPA introduced self and met with facility staff. LPA stated purpose of the visit and was allowed entry. Administrator as notified and able to attend the visit. During this complaint investigation LPA toured the facility conducting health and safety checks, reviewed facility records, and interviewed administrator and staff. Allegation: Facility staff falsified documents. Based on interviews and record reviews administrator maintains facility documents as required. Although the alleged violation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occur, therefore the allegation is Unsubstantiated. Exit interview conducted, report signed and copy of this report provided to health services director for facility records. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 20, 2026 · control 24-AS-20260413155738

Type of visit: Required - 1 Year

On 01/08/2026, Licensing Program Analyst (LPA) V. Gorban arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by administrator. LPA toured the facility with and observed with four residents in common area waiting for dinner to be served. The facility was observed to be at a comfortable temperature, of 76 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. During the visit four residents were present. Department phone number and infection prevention information signs were posted thought the facility. Inspecting kitchen LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. An emergency disaster supply was observed. A fire extinguisher was observed with service date of 01/05/2026. Private residents’ bedroom observed to be at comfortable temperatures. The bathroom’s water temperature was tested and recorded reading of 109 degrees F. Medications records storage observed to be locked in a cabinet in a hallway. Cleaning supplies were observed to be in a locked cabinet in the storage it the laundry room. An outdoor seating area was observed operational for residents in care. Facility phone number 209-354-4429 observed and tested as operational . Report continues on attached LIC809-C LPA reviewed staff and residents’ files. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): Plan of Operations · LIC 500 Personnel Report Liability Insurance · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents Please submit the above forms/information to Fresno CCL by: 01/12/2026 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. No deficiencies were observed and cited during this visit. Exit interview conducted. A report was signed, and a copy of this report was provided for facility records.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Required - 1 Year

On 01/23/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. LPA toured the facility with facility Administrator Petronila Woods, certification number 6095916740 with expiration date 02/20/2025. The facility was observed to be at a comfortable temperature, of 73 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. LPA observed some residents in common area after lunch watching television, others in their rooms resting. Department phone number and infection prevention information signs were posted thought the facility. Inspecting kitchen LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. An emergency disaster supply was observed. A fire extinguisher was observed with a service date of 11/07/2024. Private residents’ bedroom observed to be at comfortable temperatures. The bathroom’s water temperature was tested and recorded reading of 112 degrees F. Medications records storage observed to be locked in a cabinet in the kitchen area. Cleaning supplies were observed to be in a locked cabinet in the storage it the laundry room. An outdoor seating area was observed operational for residents in care. LPA reviewed staff files. No deficiencies were observed and cited during this visit. Exit interview conducted. A report was signed, and a copy of this report was provided forty facility records.the state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Required - 1 Year

On 3/5/2024, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a required annual inspection. LPA met with Administrator Petrolina Woods and announced the purpose of the inspection. Administrator certificate was current at the time of inspection. There were three residents residing in the home, one of whom is receiving hospice services. LPA toured the facility inside and outside. Pathways and exits were clear and free from obstruction. Smoke-detectors and carbon-monoxide detectors were present and operational. Facility fire extinguisher was recently serviced. Medications were secured in locked cabinet, and medications appeared to be administered properly. The fence had a self-locking latch mechanism and both pool gates were locked. There was adequate outdoor seating for residents. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, had required secure grab bars and non-skid mats, and water temperature was within required temperature range. Sharp items were secured in a locked drawer in the kitchen. LPA reviewed facility plan of operations and emergency disaster plan. LPA observed a sufficient supply of personal protective equipment and emergency food supply. Resident and staff files were reviewed. Files contained required documents and records. No deficiencies were cited during the inspection. Exit interview was conducted with the administrator. A copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 5, 2024