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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609621
Report Date:
11/16/2021
Date Signed:
11/16/2021 04:40:41 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
11/15/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20211115112448
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:
11/16/2021
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Monique Lopez
TIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Air conditioner in residents' room is not working.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with the administrator and explained the reason for this visit.
It is alleged that the air conditioner in resident #1 (R1) room is not working.
At approximately 1:30pm LPA conducted a tour of R1's room and interviewed R1 regarding the allegation. LPA also interviewed the administrator regarding the allegation at 1:15pm. Information revealed that air conditioning unit that controls R1's room also controls two other rooms and the television room. LPA observed the air conditioning unit to be a 72 degrees during the visit. LPA interviewed resident's whose rooms are also controlled by the same unit that controls R1's from 2-2:20pm. Interviews revealed that the air conditioner is working properly and no one besides R1 has an issue with the air conditioning. Facility has offered to move R1 to a different room but R1 has refused. Based on the information obtained through interviews and observation this allegation is 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:
11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/16/2021
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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