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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609621
Report Date:
11/10/2021
Date Signed:
11/10/2021 02:46:34 PM
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
11/02/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20211102131707
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:
106
DATE:
11/10/2021
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Monique Lopez
TIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff is not ensuring that resident receives a change of clothing.
Facility staff is not meeting resident's hygiene needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced initial complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit.
It is alleged that facility staff are not ensuring that resident # 1(R1) receives proper changes of clothing and that they don't ensure that R1's hygiene needs are met. LPA conducted an interview with the administrator and reviewed R1's file from approximately 10:10am-10:45am. LPA interviewed R1 from approximately 10:50-11:15am. A review of R1's file and interviews reveal that R1 does get assistance with bathing twice a week and has been regularly getting bathed. R1 does not need assistance with hygiene and feels they are good with their hygiene. During today's visit LPA observed R1 to be clean and well kept. Based on the information obtained through interviews and record review both of these allegations are deemed Unsubstantiated at this time.
Exit Interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/10/2021
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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