Golden Pond

Type of visit: Required - 1 Year

On 6/1/2026 at 12:00 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Hayden O'shea and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory of which 1 may be bedridden and a hospice waiver for 6. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. The pool is drained and locked with a secured gate. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 116.0 degrees Fahrenheit in one bathroom and 116.0 degrees Fahrenheit in the other. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 2/18/2026. Emergency Disaster Plan was last posted on 2/2/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 3/4/2026. At 12:30PM, LPA reviewed 6 of 6 residents records. At 1:15PM, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 1, 2026

Type of visit: Required - 1 Year

On 4/28/2025 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Pamela Chan and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory of which 1 may be bedridden and a hospice waiver for 6. LPA toured facility with Pamela Chan including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. The pool is drained and locked with a secured gate. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 107.8 degrees Fahrenheit in one bathroom and 106.3 degrees Fahrenheit in the other. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 12/20/2024. Emergency Disaster Plan was last posted on 5/25/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 4/18/2025. At 9:05AM, LPA reviewed 6 of 6 residents records. At 9:30AM, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 28, 2025

Type of visit: Required - 1 Year

On 5/02/2024 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator,Pamela Chan and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory of which 1 may be bedridden and a hospice waiver for 6. LPA toured facility with Pamela Chan including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. The pool is drained with a secured gate. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 117.3 degrees Fahrenheit in one bathroom and 117.5 degrees Fahrenheit in the other. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 12/20/2023. Emergency Disaster Plan was last posted on 12/28/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 3/20/2024. At 9:45AM, LPA reviewed 5 residents records. At 10:00AM, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 2, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) A. Gomez conducted an unannounced 1 Year Required visit on this date at 1:40pm. Upon arrival, LPA were greeted by Caregiver, Benjamin Filomeno. Administrator, Pamela Chan and Licensee Bernadette O'shea arrived at 1:50pm. The Administrator currently holds a certificate (#6012925740) that expires on 04/24/2024. The facility’s fire clearance is approved for six non-ambulatory of which one may be bedridden. LPA toured the facility with Administrator, including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. LPA observed pool is secured with a fence around the perimeter. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 108.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Emergency Disaster Plan was last posted on 12/28/2023 . Fire extinguisher was last services 12/20/2023. First aid kit was observed to be complete. Disaster Drill was last conducted on 11/30/2023. LPA reviewed 4 staff records and 4 of 4 staff have current first aid certificates. LPAs reviewed 5 of 5 residents records. Report continues on LIC 809-C Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 1/14/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies were cited during visit. Exit interview conducted an a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 28, 2023