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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 12/08/2022
Date Signed: 12/08/2022 01:15:18 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
11/17/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20211117114636
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:
12/08/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Monique LopezTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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1. Resident pulled a knife on another resident while in care
2. Resident's personal funds is missing while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Monique Lopez and informed her the purpose of the visit.

Allegation # 1: On 11/22/2021, LPA obtained documentation pertaining to the complaint, and attempted to contact the complainant, but was not successful. Resident # 1 (R1) was not at the facility at the time, so LPA could not interview R1. During today's visit, LPA conducted interviews with staff, and it was reported that R1 has been incarcerated since March 2022. Staff also reported to LPA, there was no incidents involving R1 with another client, and R1 never reported any issues with any other residents. Residents were interviewed, and did not know who R1 was, nor have they heard a resident pulling a knife on another resident. Therefore, based on interviews, and not able to interview the complainant or R1, there is insufficient evidence to corroborate the evidence, and the allegation is UNSUBSTANTIATED at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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-20211117114636
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: 12/08/2022
NARRATIVE
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Allegation # 2: Resident's personal funds is missing while in care . On 11/22/2021, LPA obtained documentation pertaining to the complaint, and attempted to contact the complainant, but was not successful. Resident # 1 (R1) was not at the facility at the time, so LPA could not interview R1. During today's visit, LPA conducted interviews with staff, and it was reported that R1 has been incarcerated since March 2022. LPA reviewed R1's P&I records, provided by the facility, and it showed that R1 didn't start receiving money until February 2022, even though R1 had been admitted since June 2021. Staff reported that the agency, who was providing housing funds, and expenses, took several months for R1 to start receiving P&I expenses. Documentation revealed that the balance of R1's account in March 2022, was zero, and not the money that was alleged to be stolen. Staff also reported, they were not aware of any money being stolen by R1, and it was never reported to facility staff. Therefore, due to not being able to interview R1 and the complainant, LPA has insufficient evidence to prove the allegation, and it is UNSUBSTANTIATED at this time.

Exit interview and copy of report provided.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2