Golden Life Manor I

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Vicky Valencia and the purpose of the inspection was discussed. Administrator (AD) Lorenzi Nunez was contacted by phone and arrived at approximately 12:30 p.m. During the inspection, LPA and Staff Valencia conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with three bedrooms, two bathrooms, and attached two-car garage used for storage. All resident bedrooms had the required furnishings. LPA observed all residents’ beds had linens and blankets. LPA observed residents watching television in the living room. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested between 103.8 – 120.7 degrees Fahrenheit. The backyard has a shaded sitting area and no obstacles or hazards were observed. The facility has a two-day supply of perishables and a seven-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service tag dated July 30, 2025. Gas stove, microwave, laundry washer and dryer were all observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and locked. LPA reviewed four resident files and two staff files. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 9, 2026

Type of visit: Case Management - Other

On March 12, 2025, at 8:00 AM Licensing Program Analyst (LPA) Edward Kim conducted a case management visit to follow up a request to increase capacity from five (5) nonambulatory facility to a six (6) nonambulatory facility. LPA Kim was greeted and granted entry to the facility by Caregiver (CG) Cezar Acevedo. Administrator (AD) Lorenzi Nunez arrived at the facility at 8:25 AM and LPA Kim explained the purpose of the visit. LPA Kim toured the indoor and outdoor of the physical facility with AD Nunez. LPA Kim observed and took photos of Room 1 where the facility is requesting to change the room capacity from one (1) nonambulatory to two (2) nonambulatory. An exit interview was conducted and a copy of this repot was provided to Administrator Lorenzi Nunez.the state’s words, verbatim · CDSS document, Mar 12, 2025

Type of visit: Required - 1 Year

On March 12, 2025, at 10:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Cesar Acevedo. Administrator (AD) Lorenzi Nunez arrived at the facility and LPA Kim explained the purpose of the visit. The facility is licensed to operate for five (5) nonambulatory residents and has a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living area, kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with AD Nunez. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, and Resident Room 3. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at degrees 115.5 degrees . A comfortable temperature of 75 degrees F was maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The smoke detectors and carbon monoxide detectors were operable. A working telephone (657-201-3680) and video teleconferencing device dedicated to the residents both remain available. Last emergency drill was conducted on January 3, 2025 and are conducted quarterly. First aid kit is maintained and contains all the necessary elements. Liability Insurance is effective from November 11, 2024, to November 11, 2025. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S6), and medication and medication administration record. LPA Kim conducted two (2) resident interviews and two (2) Staff interviews. Technical Violations were cited during this visit. An exit interview was conducted, and a copy of this report was provided to Administrator Lorenzi Nunez.the state’s words, verbatim · CDSS document, Mar 12, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit for the purpose of conducting a Required Annual Inspection. LPA was greeted and granted entry by caregiving staff after introducing himself and stating the purpose of the visit. Administrator Lorenzi Nunez was contacted by phone and arrived later to assist with the visit. During the inspection, LPA and administrator conducted a tour of the physical plant and observed the following: The facility is a one-story home with four resident bedrooms and two bathrooms. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets and an adequate additional supply is present. The backyard has a shaded sitting area and the route of egress is free of clutter and obstructions. There are currently four residents in care at the facility, three of which are receiving hospice care. Bathrooms faucets and toilets were operational. Water temperature tested at 109F. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Combined smoke and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with up-to-date maintenance. Sharps were observed locked in a drawer in the kitchen. LPA observed cleaning supplies to be stored in a locked cabinet under the kitchen sink and in the laundry area. The medication central storage was also observed to be secure and was reviewed during the facility visit. LPA reviewed four resident files and three staff files. Interviews conducted or attempted with the four residents present along with one staff member on duty. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 19, 2024