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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850520
Report Date: 06/03/2025
Date Signed: 06/03/2025 04:28:13 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2025 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20250505112701
FACILITY NAME:FINE GOLD MANORFACILITY NUMBER:
195850520
ADMINISTRATOR:CRISTINA GOMEZFACILITY TYPE:
740
ADDRESS:10537 MAGNOLIA BLVD.TELEPHONE:
(818) 761-5777
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91601
CAPACITY:100CENSUS: 61DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
03:24 PM
MET WITH:Christina GomezTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff are unable to communicate with residents.
Staff did not seek timely medical attention for resident.
Staff are not properly notifying resident responsible parties of incidents in a timely manner.
Licensee does not ensure facility is adequately staffed to meet residents
needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted a follow-up complaint visit for the above allegations. LPA arrived to the facility at 03:24 PM. LPA met with staff who contacted the facility Administrator Christina Gomez via telephone call. Administrator arrived to the facility at 04:02 PM. Entrance interview conducted and the reason for the visit was explained.

On 05/12/2025 LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted a file review for ten (10) residents, collected copies of pertinent documents, and conducted interviews with the Administrator, one (1) witness, and seven (7) residents between 10:33 AM. and 02:00 PM. During today’s visit, between 03:30 PM and 04:05 PM the LPA conducted four (4) staff interviews and delivered findings for the above allegations.

Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 29-AS-20250505112701
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FINE GOLD MANOR
FACILITY NUMBER: 195850520
VISIT DATE: 06/03/2025
NARRATIVE
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The allegation of “Staff are unable to communicate with residents.” alleges that facility staff are unable to assist residents due to them not understanding English. LPA interviewed the facility Administrator who stated that the facility always has English speaking staff on site. The Administrator stated that there are a couple of staff members who are able to understand English but are not proficient in speaking English. The Administrator confirmed that an English speaking staff member is always present with these staff while they are on shift. LPA interviewed seven (7) facility residents. All residents interviewed stated that staff are able to communicate with them and understand their needs. One (1) resident stated that if there is ever a communication misunderstanding another staff member will step in to assist. No residents interviewed have had issues receiving care due to a language barrier. LPA interviewed one (1) staff member, staff #1 (S1) who worked the overnight shift at the facility. S1 was fluent in English and understood the proper reporting procedures for incidents involving residents. LPA interviewed five (5) total staff. Four (4) staff spoke English fluently and one (1) staff was able to understand English. LPA interviewed two (2) witnesses. One (1) witness interviewed, witness #1 (W1) reported “minor” communication issues with staff but reported that staff are mostly consistent. Witness #2 (W2) did not report having issues communicating with staff. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff are unable to communicate with residents.” Therefore, the allegation is deemed Unsubstantiated at this time.

The allegation of “Staff did not seek timely medical attention for resident.” alleges that the facility did not seek medical attention for a resident after a medical emergency. LPA interviewed seven (7) facility residents. All residents interviewed reported that staff are quick to respond to calls for assistance. One (1) resident interviewed, resident #1 (R1) reported that the facility is quick to give medical attention during an emergency. R1 also reported that 911 was called during a recent incident right away. LPA interviewed the Administrator who stated that all facility staff are trained to respond to incidents involving residents immediately. The Administrator informed LPA that staff are notified of incidents via the facility-wide intercom system. LPA interviewed five (5) total staff. All staff interviewed stated that they are trained by the facility Administrator to respond to incidents immediately. LPA interviewed two (2) witnesses. Both witnesses interviewed had no concerns with the facility seeking timely medical attention for the residents. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of “Staff did not seek timely medical attention for resident.” Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250505112701
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FINE GOLD MANOR
FACILITY NUMBER: 195850520
VISIT DATE: 06/03/2025
NARRATIVE
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The allegation of “Staff are not properly notifying resident responsible parties of incidents in a timely manner.” alleges that the facility did not notify a resident’s responsible party of an incident involving the resident in a timely manner. LPA interviewed three (3) residents who have a responsible party to be notified in case of emergencies. Two (2) of the residents confirmed that their responsible party was made aware of incidents that occurred recently as the incidents were occurring. LPA interviewed two (2) witnesses. Both witnesses stated that they were informed of incidents involving residents as they were occurring. No witnesses had concerns about the facility not notifying them of incidents. LPA interviewed the Administrator who confirmed that front desk staff are trained to notify the responsible parties of residents in the event of an incident occurring. The Administrator stated that if the staff do not receive an answer from the responsible party a message is left, and follow-up calls are made. The Administrator showed LPA a sign located at the front desk that read "ALL STAFF When residents are transferred to hospital family members (Or next of kin) needs to be notified right away.” Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff are not properly notifying resident responsible parties of incidents in a timely manner.” Therefore, the allegation is deemed Unsubstantiated at this time.

The allegation of “Licensee does not ensure facility is adequately staffed to meet resident’s needs.” alleges that the facility is not adequately staffed throughout the day to meet the resident’s needs. LPA reviewed the facility’s staff schedule. The staff schedule reported on average approximately eleven (11) staff members on shift during the day four (4) staff on shift in the evening and two (2) staff members on shift during the night. LPA interviewed seven (7) residents. All residents interviewed reported that there are enough staff present at the facility to care for their needs. No residents interviewed had concerns about inadequate staff coverage. LPA interviewed the Administrator who stated that during the day there are three (3) caregivers, two (2) housekeepers, one (1) receptionist, the activity director, the Administrator, a cook, a dishwasher, Maintenance personnel, and an assistant for a total of approximately 12 staff on shift. The Administrator stated that there are three (3) staff members on shift overnight with an additional two (2) staff on call approximately five (5) minutes away from the facility. LPA interviewed five (5) total staff. No staff interviewed reported being overworked or short staffed at the facility. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Licensee does not ensure facility is adequately staffed to meet resident’s needs.” Therefore, the allegation is deemed Unsubstantiated at this time.
No deficiencies were cited during today’s inspection. A copy of the report was printed and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3