Golden Valley Residential Care Facility

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 03/27/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Lovelyn Baay. A brief interview was conducted with the facility designated Administrator at this time. Current census was 5 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 03/16/2026. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 03/16/2026: The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. Licensees shall maintain in the personnel records verification of required staff training and orientation. Plan of Correction clearance letter was printed and a copy was provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Mar 27, 2026

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 03/16/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregivers, Nora Casaverde and Nelia Baay, who were briefly interviewed at this time. This LPA requested that they go ahead and contact the facility designated Administrator, Lovelyn Baay, to inform her that CCL was present at this time. Current census was 5 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (3) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. It was learned that this facility does not have a bedridden fire clearance to be able to accept or retain any residents deemed to be bedridden at any given time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Garage area was toured. Laundry area, located next to the garage area, was toured and observed to be locked at this time. A review of the bleach, detergent, and all other cleaning supplies was conducted to make sure that they were locked and made inaccessible to the residents at this time. Administrator certificate # 7005498740 for Lovelyn Baay which was observed to expire on 08/14/2026 and in compliance at this time. Medication cabinet, located in the facility office cabinets, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the office cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher located hanging on the wall adjacent to the kitchen was observed to have been annually purchased from the local Costco Wholesale. The purchase receipt was attached and displayed a purchase date of 12/29/2025 and observed to be in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees at all times. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (4) facility personnel records was conducted and noted on the following LIC 859. A review of (5) facility resident records was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a version was given to the facility staff persons at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Mar 16, 2026

Type of visit: Required - 1 Year

On 03/18/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by Facility Designated Administrator (FDA), Lovelyn Baay and explained the purpose of the visit. There were two other staff members present, Nelia Baay and Nora Bay Casaverde. Current Census was 2. A brief interview with FDA Baay was conducted. This facility is licensed to serve 6 elderly residents. 3 out of 6 residents any be non-ambulatory. This facility also has a hospice waiver for 3 residents. LPA reviewed 2 staff files. 2 out 2 staff files are complete and up to date. LPA reviewed 2 resident files. The administrator has an active Administrator Certificate #7005498740 expires 08/14/2026. A tour of the facility was conducted. Carbon monoxide and smoke alarms were present and were observed to be in good repair. Fire extinguisher in the facility was present and was purchased with attached receipt 11/21/2024. The kitchen area was toured. LPA observed a 7-day non-perishable and 2 day perishable foods in the cabinets and refrigerator. Additional non-perishable food supplies were identified in the cabinet in the hallway. LPA observed a locked centralized stored medication cabinet located. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. A tour of the garage was conducted. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL -LIC 308 -LIC 400 -LIC 500 -LIC 610 -Liability Insurance An technical violation was provided for Section 87411(c). No deficiencies were observed or cited during this annual visit. A copy of this report was given to Facility Designated Administrator. Exit interview was conducted.the state’s words, verbatim · CDSS document, Mar 18, 2025

Type of visit: Required - 1 Year

On 03/28/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by Facility Designated Administrator (FDA), Lovelyn Baay and explained the purpose of the visit. There were two other staff members present, Nelia Baay and Nora Bay Casaverde. Current Census was 4. A brief interview with FDA Baay was conducted. This facility is licensed to serve 6 elderly residents. 3 out of 6 residents any be non-ambulatory. This facility also has a hospice waiver for 3 residents. LPA reviewed 3 staff files. 3 out 3 staff files are complete and up to date. LPA reviewed 4 resident files. The administrator has an active Administrator Certificate #601539740 and is valid until 08/14/2024. A tour of the facility was conducted. Carbon monoxide and smoke alarms were present and were observed to be in good repair. Fire extinguisher in the facility was present and was purchased with attached receipt 11/29/2023. The kitchen area was toured. LPA observed a 7-day non-perishable and 2 day perishable foods in the cabinets and refrigerator. Additional non perishable food supplies were identified in the cabinet in the hallway. LPA observed a locked centralized stored medication cabinet located. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. A tour of the garage was conducted. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL -LIC 308 -LIC 400 -LIC 500 -LIC 610 -Liability Insurance The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Code. Appeal rights were printed and a copy was given to the facility designated Administrator. Exit Interview.the state’s words, verbatim · CDSS document, Mar 28, 2024