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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 08/05/2022
Date Signed: 08/05/2022 11:21:55 AM

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
08/04/2022 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20220804093150
FACILITY NAME:GOLDEN ASSISTED LIVINGFACILITY NUMBER:
197609621
ADMINISTRATOR:LOPEZ, MONIQUEFACILITY TYPE:
740
ADDRESS:14060 ASTORIA STTELEPHONE:
(818) 367-1947
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:128CENSUS: 115DATE:
08/05/2022
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Monique LopezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Insufficient staffing to meet residents' needs
Staff left resident in wet clothing for extended periods of time
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 administrator and explained the reason for this visit.
LPA conducted a physical plant tour from 8:45-9am to ensure no immediate health and safety issues were present, none were noted during the tour.
Insufficient staffing to meet resident's needs & Staff left resident is wet clothing for an extended period of time.
It is alleged that there is a lack of staff that has led to resident # 1 (R1) not being changed in a timely manner and having to sit in soiled clothing for a long period of time. LPA conducted interviews with R1 and other residents from 9:10-10:15am who require incontinent assistance. LPA also reviewed R1's facility file and obtained copies of pertinent information from 10:15-10:40am. LPA conducted an interview with facility staff regarding this allegation from 10:45-11am. Information obtained through interviews reveal that residents are being changed in a timely manner and that there is no issue with staffing. 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 HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
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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