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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609621
Report Date:
01/21/2022
Date Signed:
01/21/2022 02:46:52 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
01/18/2022
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20220118094523
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:
103
DATE:
01/21/2022
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Monique Lopez
TIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Financial Abuse
Staff are not assisting resident with bathing needs
Staff do not safeguard a resident's property
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 allegations above. LPA met with the administrator and explained the reason for this visit.
Financial Abuse
It is alleged that resident #1 (R1) has not been receiving their portion of their social security funds and that R1 has never received their amount. LPA conducted an interview with the administrator regarding this allegation from 11-11:30am. LPA was not able to interview R1 who was not at the facility and does not have a telephone. LPA reviewed R1's file which included R1's cash resources from 11:30-12pm. A review of R1's facility file revealed that Brilliant Corners pays R1's rent and sends the balance of R1's social security to the facility. LPA was able to obtain the cash resource log and verify the cash noted on the log with the cash the facility has for R1. LPA also observed that R1 did withdraw from their account twice in November of 2021. Based on the information obtained this allegation is deemed Unsubstantiated at this time. LPA was able to verify that no money was missing from R1's funds and that R1 does have access to their funds.
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:
01/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/21/2022
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
2
Control Number
31-AS-20220118094523
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
GOLDEN ASSISTED LIVING
FACILITY NUMBER:
197609621
VISIT DATE:
01/21/2022
NARRATIVE
1
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3
4
5
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8
9
10
11
12
13
14
15
16
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20
21
22
23
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32
Staff are not assisting resident with bathing needs
It is alleged that facility staff are not assisting R1 with their bathing needs. LPA conducted an interview with the administrator regarding this allegation. LPA also reviewed R1's physician report and needs and service plan from 11:30-12pm. Information obtained from R1's file revealed that R1 is able to bath on their own. Information from interviews with facility staff and the complainant indicated that R1 leaves the facility at approximately 5 am in the morning and does not return until after 6 pm and has rejected any assistance when they have come back to the facility. Based on the information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time.
Staff do not safeguard a resident's property
It is alleged that R1's stuff goes missing from their room when staff cleans it. LPA conducted an interview with R1's roommate regarding this allegation from 12:15-12:30pm. LPA obtained and reviewed R1's personal valuables and property list. LPA also interviewed the administrator regarding this allegation. Information obtained from interviews revealed that there has been no items taken from R1's room. A review of R1's valuables and property list show everything on their is still in the room. R1 has not informed the facility of any items missing from their room. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Exit interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
01/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/21/2022
LIC9099
(FAS) - (06/04)
Page:
2
of
2