197609621-4-17-2021-31-AS-NMAN-C6VPMH-20210915112621

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 04/16/2021
Date Signed: 04/17/2021 08:41:54 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210413133124

FACILITY NAME:	GOLDEN ASSISTED LIVING		FACILITY NUMBER:	197609621
ADMINISTRATOR:	LOPEZ, MONIQUE		FACILITY TYPE:	740
ADDRESS:	14060 ASTORIA ST		TELEPHONE:	(818) 367-1947
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	128	CENSUS: 110	DATE:	04/16/2021
		UNANNOUNCED	TIME BEGAN:	12:21 PM
MET WITH:	Marilyn Nguyen - Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff does not provide wash towels to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with administrator Marilyn Nguyen and explained the reason of the visit. Entrance interview conducted.

At 12:25 PM, LPA conducted interview with residents and staff. At 2:25 PM, LPA conducted physical plant tour. LPA interviewed twelve (12) residents or more than 10% of the current facility census and conducted physical plant. LPA interview with residents revealed that staff get the used towels and replaced it with fresh ones everyday. LPA physical plant tour revealed that the facility has a roomful stock of towels and linens in the linen room. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

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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