197609621-9-28-2021-31-AS-RRAZ-CKJJCH-20221025065557

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 09/25/2021
Date Signed: 09/28/2021 06:58:32 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
07/08/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210708160740

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: 107	DATE:	09/25/2021
		UNANNOUNCED	TIME BEGAN:	08:39 AM
MET WITH:	Marilyn Nguyen - Licensee		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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COVID: staff and residents do not wear a mask in common area
COVID: staff were not taking residents temperature
Facility staff do not respond to residents call button
Facility is not clean
Facility is cold
Resident's drawers do not have knobs
Facility does not provided hand soap/towels for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Licensee Marilyn Nguyen and explained the reason for the visit.

LPA conducted physical plant tour at 9:00 AM, requested facility documents relevant to the investigation at 9:38 AM and conducted interview with staff and residents between 10:30 AM and 1:50 PM.

Regarding the allegation that the staff and residents do not wear mask in common areas. LPA's observation during physical plant tour on 07/13/21 at 9:20 AM, Virtual physical plant tour on 12/18/2020 at 2:38 PM and today's visit at 9:38 AM, revealed that all the staff were wearing mask while working in the facility.

Based on the information gathered during this and prior visits, the allegation is deemed unsubstantiated at this time. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2021

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-20210708160740

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: 09/25/2021

NARRATIVE

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Regarding the allegation that staff were not taking residents temperature, LPA's record review today at 10:00 AM, revealed that the facility staff regularly take the temperature of all residents especially during the outbreaks at the facility, records shows however that some residents refused to do so. LPA's interview with staff on 07/13/21 at 11:35 AM and today at 11:12 AM revealed that facility abide by the guidance provided by the Los Angeles County Department of Public Health but can't force any resident if they refused.

Regarding the allegation that the staff do not respond to call button, LPA's interview with eleven (11) residents or more than 10% of current census on 07/13/21 between 10:50 AM and 12:35 PM and today between 10:30 AM and 1:50 PM, revealed that staff come in within reasonable time when called upon whether by call button, by phone or in person in the office.

Regarding the allegation that facility is not clean, LPA's observation during physical plant tour on 07/13/21 at 9:20 AM and today's visit at 9:00 AM, revealed that all the common areas are clean and in proper order.

Regarding the allegation that the Facility is cold, LPA's observation during physical plant tour on 07/13/21 at 9:20 AM and today's visit at 9:00 AM revealed that the temperature setting on the air conditioning all over the facility was set between 70°F to 75°F and within the required range.

Regarding the allegation that Resident's drawers do not have knobs, LPA's observation during physical plant tour on 07/13/21 at 9:20 AM and today's visit at 9:38 AM revealed that the random residents' drawer visited are in good repair. During LPA's visit for another complaint (cc no.: 31-AS-20210726153616) on 07/26/2021 at 1:35 PM, LPA's interview with Resident #1 (R1) at 2:00 PM revealed that R1 did not report the broken knob to the administrator or staff of the facility, while interviewing R1, LPA summoned the facility handyman and observed that the knob was immediately replaced by the staff and even changed the non-working lamp of R1.

Regarding the allegation that Facility does not provided hand soap/towels for residents, LPA's observation during physical plant tour on 07/13/21 at 9:20 AM, 05/12/21 at 9:15 AM, 04/16/21 at 2:35 PM and today's visit at 9:00 AM revealed that R1's room has a fresh towel and hand soap on R1's bathroom.

Based on the information gathered during this and prior visits, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2021

LIC9099 (FAS) - (06/04)

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