197609621-8-26-2021-31-AS-EMIR-CHNTUW-20220826150259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 08/26/2021
Date Signed: 08/26/2021 02:01:32 PM

Unsubstantiated

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
08/24/2021 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 31-AS-20210824153455

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: 105	DATE:	08/26/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Monique Lopez		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility does not have hot water.
Facility is dirty and unkempt.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) conducted an unannounced visit on this day in response to the above allegation.

As part of this investigation, on 8/26/21 at 11:00am, LPA interviewed 11 residents and observed the hot water temperature in their rooms to be between 105 and 120 degrees Fahrenheit.
Allegation #1, that "facility does not have hot water" has been unsubstantiated based on observations and interviews. 11/11 residents interviewed confirmed that the hot water is currently working, and 9/11 stated that they have never experienced any problems with the water or hot water functioning properly. At 1:00pm Administrator stated that there are upcoming plumbing repairs planned, and confirmed that all residents are given notice of any planned water turnoffs. Administrator stated that she does not recall any confirmed instances, or credible claims, of the facility's hot water not working.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Alexander Pitz	TELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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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Control Number 31-AS-20210824153455

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: 08/26/2021

NARRATIVE

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Allegation #2, that "Facility is dirty and unkempt" has been unsubstantiated based on the interviews conducted an observations made. 10/11 of the residents interviewed at 11:00am stated that they do not have any problems or concerns with the facility's cleanliness. Throughout LPA's visit housekeepers were observed doing rounds and cleaning various parts of the facility.

Report reviewed, signed and delivered. Exit interview conducted, no deficiencies cited.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Alexander Pitz	TELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC9099 (FAS) - (06/04)

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