Golden Valley Home Care for Elderly

Type of visit: Required - 1 Year

On May 26, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the annual inspection visit. LPA initially met with the staff on duty, Emiliana Mariano (S1) and stated the purpose of the visit. The licensee/administrator, Emelita Madriaga (AD), was notified and arrived shortly after. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 ambulatory/non-ambulatory residents. Facility does not have clearance for bedridden, delayed egress, and/or locked interior/exterior. Facility does not manage resident cash resources. Facility does not have hospice waiver at this time. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA inspected 3 resident bedrooms and 2 bathrooms. Bathrooms are equipped with non-skid flooring and grab bars. Advisory was provided to secure the grab bars with more screws as they were observed to be slightly loose. Faucet, toilet and shower are in working condition. Hot water temperature was 110 degrees Fahrenheit in one of the bathrooms. Room temperature was maintained at 72 degrees Fahrenheit throughout this visit. In the kitchen, LPA observed at least 7-day nonperishable and 2-day perishable food items. Knives/sharps and cleaning chemicals were locked under the sink. Advisory was provided to obtain thermometers for the kitchen refrigerator and freezer. Advisory was provided to ensure variety of fresh fruits and vegetables were available to residents. Fire extinguisher was observed in the kitchen area and last serviced on 6/20/2025. The converted garage is labeled “staff” and this is where they store medications and facility records. Additional refrigerator and freezer were in this staff room. {1 of 2} The exit at the kitchen area going to the backyard does have a ramp. Outdoor area was inspected. Walkways were observed to be unobstructed. Fence and gate were in good repair at this time. No bodies of water were observed at this time. There is a shaded area for outdoor activities. LPA observed outdoor furniture. Shut off valves (water and electricity) were identified; no gas shut off valve at this time. Record Reviews: Review of 3 of 5 resident files was conducted, including but not limited to, review of Admission Agreement, Physician Reports, and Ambulatory Status. PRN Authorization letters were on file. Advisory provided to ensure they update this form when needed. Needs and Services Plan for 1 of 3 residents was not completed; 2 of 3 residents needs their Needs and Services Plan updated annually. At least 2 residents were assessed to be at risk if they have access to personal/hygiene items. Advisory was provided to facility to ensure they appropriately store these items so that those residents who are at risk do not have direct access. Advisory was provided to facility that there is a new LIC602A form that they can utilize to ensure they are in compliance with the new dementia regulations. Medication review was conducted for 2 residents, including review of resident’s medication, PRN authorization letter, prescription records, Centrally Stored Medication Records, and Medication Administration Records. Advisory was provided to facility to ensure they have updated prescription records. Review of 3 staff files included but not limited to background clearance, first aid/CPR certification, and training. Administrator certificate expires on July 2027. Advisory was provided to ensure all staff, including those who are “back up” or “reliever” from time to time have their current first aid/CPR certification on file. LPA reviewed Emergency Disaster Plan, and they are reviewed at least annually. Fire/Emergency Drill was last conducted 5/17/26. Fire alarm was activated and LPA observed the magnetic fire door closed automatically when the alarm was activated. Infection Control Plan was reviewed, and advisory was provided to facility to review their plan at least annually. Advisory was provided to facility to review their dementia care plan to ensure it is in compliance with the new dementia regulations. Documents Requested: LPA requested a copy of updated Liability Insurance, LIC500, and LIC308. Per the California Code of Regulations, Title 22, Division 6, deficiencies were cited. Exit interview was conducted with AD. A copy of the report was provided upon exit. {2 of 2}the state’s words, verbatim · CDSS document, May 26, 2026

The state marks this report as 20 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 05/20/2025 at 8:30am, Licensing Program Analyst (LPA) Pang Lee and Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA's met with administrator Emelita Madriaga and explained the purpose of the visit. The current census is 4 with 4 facility staff. This facility is a single story building licensed to serve (2) non-ambulatory and (2) ambulatory residents. LPA's inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA's observed the facility to be free of odor, clean and in good repair. LPA's observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA's toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 120.2 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen area and was last serviced on 07/05/2024. LPA's observed the facility has a public telephone in the dining area and the facility has the required posters posted. Facility thermostat was observed at 73 degrees Fahrenheit. LPA's observed toxins located in the hallway closet and kept locked and inaccessible to residents. LPA's observed sharp knives kept locked in the kitchen and inaccessible to residents. Continuation 809-C LPA's checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 2 out of 4 residents medications and the medication administration record (MAR) was complete. During today's visit it was learned that administrator pre-doses medications. Administrator states, at the last annual inspection they were not advised that pre-dosing medication was a non-compliance issue. The first aid kit was checked and contained the required components. LPA's requested resident and staff files for review. LPA's reviewed 4 out of 4 resident files and they were complete. LPA's reviewed 3 out of 3 staff files and it was complete. LPA's reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents will be email to LPA by end of day today 5:00 PM: (1) LIC 610 Current Emergency Disaster Plan As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Emelita and a copy of these LIC 809, LIC 809-C, and LIC 9102-TV pages, were provided to the facility.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced 1 Year Required Annual Inspection Visit. LPA met with the Administrator and explained purpose of the visit. Administrator Certificate expires 7/17/2025. LPA and administrator toured the facility and inspected physical plant including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in the facility. LPA measured the hot water temperature in resident's bathroom at 110.9 degrees Fahrenheit which is within the required range of 105 to 120 degrees. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire Extinguisher last inspected 7/6/2023 and smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present and in working order. The facility conducts fire/disaster drills with residents on 2/24/2024. LPA observed centrally stored medications, knives and toxins locked and not accessible to residents. LPA reviewed four resident files and two staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. First aid/CPR certificates are current. First aid kit was checked and is complete. LPA received the updated documents for community care licensing on today's date: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, Copy of Administrator's Certificate, and Copy of Liability Insurance. Based on today’s visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies observed or cited today. Exit interview conducted with administrator. A copy of report and LIC 811 (Confidential Names) left at facility.the state’s words, verbatim · CDSS document, Apr 10, 2024