197609621-1-5-2022-31-AS-MVAO-CLWQ44-20221208104942

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 01/05/2022
Date Signed: 01/05/2022 12:19:20 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
12/22/2021 and conducted by Evaluator Nicholas Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211222154322

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:	01/05/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Monique Lopez		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Illegal drugs on the premises
Facility failed to provide a comfortable temperature for residents
Facility is in disrepair
Facility has an infestation of rats and roaches
Staff failed to respond to residents’ call assistance button in a timely manner
Facility failed to provide adequate food service
Staff opened resident’s mail without his consent
Staff failed to protect resident from being harmed by other residents
Staff failed to take precautions for COVID-19

INVESTIGATION FINDINGS:

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At approximately 9:50 AM on 01/05/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted a subsequent visit for Complaint Control Number 31-AS-20211222154322. LPA met with Administrator Monique Lopez and disclosed the reason for the visit. Resident census was 105.
From 9:55 AM to 11:21 AM, LPA interviewed residents.
From 11:23 AM to 11:34 AM, LPA conducted a physical plant tour.

Regarding the allegation “Illegal drugs on the premises”, it was alleged that residents at the facility take illegal drugs (Crystal Methamphetamine) on the premises and the facility is aware of it. LPA interviewed staff and residents on 12/28/2021 and 01/05/2022 about this allegation. Based on interviews, LPA determined there are no illegal drugs on the premises. LPA also conducted two physical plant tours on 12/28/2021 and 01/05/2022. LPA did not observe any illegal drugs on the premises.

Based on information obtained, the allegation is deemed unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

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 3

Control Number 31-AS-20211222154322

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: 01/05/2022

NARRATIVE

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Regarding the allegation “Facility failed to provide a comfortable temperature for residents”, it was alleged that the facility is freezing cold, all residents wear layers of clothing, and the facility does not turn the heater on. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, facility staff adjust the thermostat upon request, turning the heater or air conditioner on or off as needed.

Based on information obtained, the allegation is deemed unsubstantiated at this time.

Regarding the allegation “Facility is in disrepair”, it was alleged that the structure of a room is damaged; the room has a large draft and the cold wind comes in from there. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, the Administrator fixes the building when it is reported or needed. LPA conducted a physical plant tour on 01/05/2022. LPA inspected the room alleged to have a large draft. Based on LPA inspection, there is no draft in the room.

Based on information obtained, the allegation is deemed unsubstantiated at this time.

Regarding the allegation “Facility has an infestation of rats and roaches”, it was alleged that the facility has an infestation of rats and roaches. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, there is no infestation of rats and roaches in the facility. From physical plant tours on 12/28/2021 and 01/05/2022, LPA observed no roaches, rats, or signs thereof. Based on physical plant tours, there is no infestation of rats and roaches. LPA conducted a Records Review on 12/28/2021 of the 4 previous months’ fumigation receipts. Based on Records Review, the Licensee fumigates the facility regularly.

Based on information obtained, the allegation is deemed unsubstantiated at this time.

Regarding the allegation “Staff failed to respond to residents’ call assistance button in a timely manner”, it was alleged that each residents’ room has an emergency call assistance button and whenever any of the resident press the emergency call button, the staff don’t respond to it and simply shut it off. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, the staff promptly attend to calls for assistance.

Based on information obtained, the allegation is deemed unsubstantiated at this time.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20211222154322

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: 01/05/2022

NARRATIVE

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Regarding the allegation “Facility failed to provide adequate food service”, it was alleged that the facility serves is poor quality, the portions are very small. LPA conducted a physical plant tour on 12/28/2021 and observed the kitchen area, menu, and prepared food portions. Based on LPA observations, the facility serves food of adequate nutrition and size. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, the facility’s food service is adequate.

Based on information obtained, the allegation is deemed unsubstantiated at this time.

Regarding the allegation “Staff opened resident’s mail without his consent”, it was alleged that several times the staff opened a resident’s mail and threw it away without consent. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, residents receive their mail from the office or from staff.

Based on information obtained, the allegation is deemed unsubstantiated at this time.

Regarding the allegation “Staff failed to protect resident from being harmed by other residents”, it was alleged a resident was punched several times in the face and head by other residents. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, there are no incidents of violence, though there are arguments and yelling. When arguments happen, staff separate residents until they are calm and safe.

Based on information obtained, the allegation is deemed unsubstantiated at this time.

Regarding the allegation “Staff failed to take precautions for COVID-19”, it was alleged that the facility staff are not taking any precautions for COVID-19 and are not practicing social distancing. LPA conducted a physical plant tour on 12/28/2021 and observed signs throughout the facility promoting mask wearing and social distancing. LPA also observed staff wearing masks throughout the facility. Based on LPA observations, the facility takes adequate precautions for COVID-19.

Based on information obtained, the allegation is deemed unsubstantiated at this time.

LPA conducted exit interview and issued report

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC9099 (FAS) - (06/04)

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