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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157203336
Report Date: 03/26/2021
Date Signed: 03/29/2021 11:40:08 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/05/2021 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210105111533
FACILITY NAME:GOLDEN CASTLE ASSISTED LIVINGFACILITY NUMBER:
157203336
ADMINISTRATOR:BRIZUELA, PAULA MARIBELFACILITY TYPE:
740
ADDRESS:2607 MOUNT VERNON AVENUETELEPHONE:
(661) 871-8133
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:49CENSUS: DATE:
03/26/2021
UNANNOUNCEDTIME BEGAN:
02:29 PM
MET WITH:Maribel BrizuelaTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Resident was sexually abused while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) L. Xiong called and spoke with Administrator Maribel Brizuela regarding the complaint allegation. Findings were delivered over the phone due to COVID 19 precautionary guidelines.

Licensing Program Analyst (LPA) L. Xiong conducted the subsequent complaint investigation tele-visit to the facility. During the course of this investigation, the Department interviewed staff on duty and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. Resident R1 was sexually abused while in care since the facility fail to take action to protect R1 at the facility. Based on the Department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Les XiongTELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 24-AS-20210105111533
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: GOLDEN CASTLE ASSISTED LIVING
FACILITY NUMBER: 157203336
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/09/2021
Section Cited
CCR
87468.1(a)(1)(2)(3)
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87468.1 (a)(1-3)
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
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Per Administrator, Personal rights and Care and Supervision training will be provided to all staf, and submit training documentation to Community Care Licensing by April 9, 2021.
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(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
This evidence was not met as evidence by:
The facility failed to take action to protect R1 resulting R1 being sexually abused while in care. **This presents a potential risk to the health and safety of the persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Les XiongTELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
LIC9099 (FAS) - (06/04)
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