Golden Horizon Home 1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Robert Campbell conducted an unannounced annual required visit. Upon entry, LPA were greeted by Myrnalyn Arce, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff member and six (6) residents present. Facility Overview: The facility is a one-story home with seven (7) bedrooms and three (3) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 129°F. LPA issued a technical violation for water temperature being to high, staff lowered water temperature at time of visit. Fire extinguishers located in multiple areas and they had current inspection tag.(9/02/2025) Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for four (4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five (5) resident files were reviewed and contained all the required documents. Technical assistance was given to staff not having updated training, and residents not having reappraisals done every twelve (12) months. Health-Related Services/Incidental Medical Services: All resident medications were securely locked in hallway closet by the kitchen. LPA reviewed medications for six (6) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. LPA issued an Technical Violation for staff having medication pre-poured transferred in medication cups prior to administration. Personal & Incidental Funds: All residents monies are not handled by the facility. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on 6-05-2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Jun 24, 2026

Type of visit: Required - 1 Year

On 6/19/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Caregiver, Myrnalyn "Myrna" Arce who was informed of the purpose of the visit. Administrator, Grace-Marie Tomas was contacted over the phone and also informed of the purpose of LPA's visit. Tomas' administrator certificate expires on 9/14/2026. The facility has a fire clearance to serve six (6) non-ambulatory elderly residents of which one (1) may be bedridden. The facility also has an approved hospice waiver for two (2) and LPA was informed one (1) resident is currently receiving hospice services at the facility. During today's visit, there was two (2) staff and six (6) residents present. LPA toured the facility with Caregiver Arce and observed the facility is made up of a one-story home with six (6) resident bedrooms, two (2) bathrooms, two (2) dining rooms, two (2) living rooms, a staff room, kitchen, laundry room, and attached garage. Resident bedrooms had the required bedding, furniture, and lighting. Bathrooms had grab bars and non-skid mats in the showers. No bodies of water were observed on the premises. Indoor and outdoor pathways were free of obstruction. The facility has a two-day supply of perishable foods and seven-day supply of non-perishable foods. Medications are secured in a locked dining room cabinet. LPA observed several hallway cabinets filled with additional towels, bedding, and linens available for resident use. Arce tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed multiple charged fire extinguisher mounted throughout the facility that were last serviced on 8/15/2024. The facility's certificate of liability insurance expires on 6/26/2025. Staff present have a criminal record clearance and are associated with the facility. Arce has a valid first aid/CPR certificate. The facility's last fire drill was conducted on 6/2/2025. Long Term Care Ombudsman's contact information, residents' personal rights, complaint procedures, emergency phone numbers, and facility sketch are visibly posted near the front entrance and dining room. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Arce.the state’s words, verbatim · CDSS document, Jun 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began. Five (5) records were reviewed. LPA reviewed for admission agreement-one missing, medical assessment-one expired and TB test results-one missing, consent forms-all missing, identification and emergency information, appraisal needs-one missing and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is not meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 115.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. (Continued on next page) (Continued on from Page 1) LPA began review of employee records. Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening-one missing and TB test results-one missing, criminal record statement, employee right-two missing, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 08/16/2023. The facility is conducting emergency disaster drills quarterly. The last disaster drill was conducted on 06/12/2024. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, the following four (4) deficiencies is being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the facility representative. Appeal Rights were also provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Jun 21, 2024