Golden Pine Guest Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff, LPA explained the purpose of the visit to staff. Administrator certificate # 7036253740 expires 11/04/2026. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 15 bed facility with a current census of 15. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals and medications noted to be locked to residents in care. LPA also conducted the care tool. No bodies of water were observed at the facility. Hot water temperature was measured at 110 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 06/23/2025 and is expired smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance. LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed three (3) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. Exit interview held with staff and copies of reports left at conclusion of visit.the state’s words, verbatim · CDSS document, Jul 21, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff LPA explained the purpose of the visit. LPA and staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 15 bed facility with a current census of 15. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals and medications noted to be locked to residents in care. LPA also conducted the infection control domain tool. No bodies of water were observed at the facility. Hot water temperature was measured at 110 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 06/23/2025 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance. LPA reviewed five (5) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed five (5) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. Exit interview held with staff and copies of reports left at conclusion of visit.the state’s words, verbatim · CDSS document, Jul 2, 2025

Type of visit: Case Management - Health Checks

On 9/18/2024, LPA Kesha Lewis made an unannounced visit on this date to conduct a health and safety check. LPA met with staff Joyce Martin. The temperature in the facility was a comfortable 77 degrees in the main area facility is clean and sanitary. Staff state that R1 received all medication and belonging when being moved to facility on 8/26/2024. R1 has seen their physician to get continued medication and is in room E. Health and Safety check today included overall safety of the facility including food supply, physical plant and staffing. Exit interview and copy of report given.the state’s words, verbatim · CDSS document, Sep 18, 2024

Type of visit: Required - 1 Year

On 06/13/2024 Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Joyce Martin and explained the purpose of the visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds a current certificate and expires on November 04, 2024. The facility is licensed for fifteen ambulatory residents, which one can be non-ambulatory . There are currently 13 residents who reside at this facility. The LPA Martinez toured the facility with Joyce Martin on 06/13/2024 at 1:00 PM. The facility has a natural disaster plan and the last fire drill was on February 10, 2024. LPA Martinez reviewed five resident files and 3 staff files, which were maintained. LPA Martinez requested a copy of liability insurance and fire inspection, which will be emailed to LPA Martinez. LPA Martinez reviewed two medication administration records (MAR), and both MARs were maintained. The facility has a first aid kit, and medication is stored in locked cabinet. The smoke detectors, carbon detectors, and fire extinguishers were in good repair. The facility bathrooms, kitchen, bedrooms, laundry room, and common areas were furnished and sanitary. The facility has an adequate food supply. The facility water temperature measured 105 degrees, and facility temperature measured at 73 degrees. Based on this annual inspection, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 13, 2024