Golden Peak Living

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Olivia and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Advisory given for food service /checking dates. Hot water temperature was measured at 128 degrees Fahrenheit in resident bathroom sink, which is not within the required range of 105 to 120 degrees. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 2 resident and 1 staff files, including criminal record clearances. The first aid kit was checked and is complete. Continued The smoke detectors are current and in compliance with fire safety. Fire extinguishers needs service, they were last serviced on 2/7/2025. Per California Code of Regulations, Title 22 Division 6, Chapter 8 and Health and Safety Code, Deficiencies were cited during this visit. Exit interview held and a report given at the conclusion of the inspectionthe state’s words, verbatim · CDSS document, Aug 27, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Aug 28, 2026

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by:observation the fire extinguishers need service, they were last serviced on 2/7/2025. This is an immediate safety concerns for residents in care.the state’s words, verbatim · CDSS document, Aug 27, 2026

Plan of correction: Administrator will address the deficiency cited and service fire extinguisher and submit new tags by POC date showing corrections have been made. ****Fire Clearance Violation****** ****Immediate $500 Civil Penalty**** If additional time is needed please email your request for an extension by 8/28/26

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(e)(2) · Plan of correction due date: Sep 11, 2026

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:Hot water temperature was measured at 127.5 degrees Fahrenheit in resident's bathroom sink, which is not within the required range of 105 to 120 degrees. This is a potential risk to residents in carethe state’s words, verbatim · CDSS document, Aug 27, 2026

Plan of correction: Administrator will adjust the water heater immediately and ensure that the water is within regulation. Administrator will conduct a water temperature check that will include a water log until 9/11/26. The water log will be emailed to LPA by POC date 09/11/26 by end of day 5:00 PM.

Type of visit: Prelicensing

Licensing Program Analyst Noel Wolf Petersen arrived on 8/13/25 at 1:00 pm to conduct a prelicensing inspection for Golden Peak Living, he met with Licensee Doderlien Anaya Fernandez and explained the purpose of the visit. Golden Peak Living is preparing to be a 5 bedroom facility serving 6 clients, 2 nonambulatory and 4 ambulatory. Physical plant was inspected, including but not limited to the kitchen, common areas, resident bedrooms, resident bathrooms, exteriors, and evacuation routes. the facility is clean, the hallways are well lit and unobstructed. the kitchen has lockable storage for MARS and medications. the First aid kit contains all necessary items. Required posters are in place and of the correct dimension. The client bathrooms have hardware and are in good repair, water is delivered within the required 105-120*f, and contain covered trash cans. bedrooms have required furniture and furnishings, LPA mentioned the inclusion of bed bug deterring zipperable plastic covers for the mattresses, the licensee was receptive. The exteriors have room for activizes, and free of tripping hazzards, the evacuation exit is in good repair. Storage areas for toxics and sharps are lockable. fire extinguisher is dated 2/12/25. 2 days of perishable and 7 days of non perishable food are stored. Administrator files including but not limited to the program design, admission agreement, evacuation procedure, infection control plan, control of the property, and facility sketch are present and up to date. the surety bond is not in use as the facility does not intend to hold client cash. LPA asked for proof of liability insurance to be emailed to the LPA before a resident is accepted into care. Delivered the comp III presentation. Facility is ready for licensure pending department approval. An Exit interview was conducted, a copy of the report was read and given to the administrator.the state’s words, verbatim · CDSS document, Aug 13, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Interview Method: Telephone interview On 7/28/2025, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / 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. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/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 readinessthe state’s words, verbatim · CDSS document, Jul 28, 2025