197609621-11-15-2022-31-AS-NMAN-CNGRJB-20230127120341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 11/15/2022
Date Signed: 11/15/2022 03:04:21 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
11/07/2022 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20221107155526

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: 116	DATE:	11/15/2022
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Monique Lopez		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility staff did not prevent residents from sneaking illegal drugs and alcohol inside the facility.
Lack of supervision resulting in residents engaging in a physical and verbal altercations.
Female residents were inappropriately touched by male residents.
Facility food services are inadequate.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced initial complaint visit to investigate the above allegations. Upon entry, LPA met with the administrator, Monique Lpoez, and discussed the reason for the visit.

--- Facility staff did not prevent residents from sneaking illegal drugs and alcohol inside the facility.

It was alleged that residents are sneaking drugs and alcohol into the facility. To investigate the allegation, on 11/15/2022 at 9:30 AM LPA reviewed records, at 10:00 AM, LPA made observations during a physical plant tour, at 11:00 AM, LPA interviewed residents and at 1:00 PM, LPA interviewed staff. A review of the Department’s records revealed that the facility has not reported any Incident Reports involving the use or possession of illegal drugs and/or alcohol. During a physical plant tour, LPA did not observe any alcohol, empty bottles of alcohol, drugs or drug paraphernalia in the facility.
(Cont. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

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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Control Number 31-AS-20221107155526

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: 11/15/2022

NARRATIVE

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During interviews, all residents and staff stated that they have never witnessed or know of anyone sneaking or using drugs and/or alcohol in the facility. Based on record reviews, observations and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time.

--- Lack of supervision resulting in residents engaging in a physical and verbal altercations.

It was alleged that residents are engaging in physical fights and yelling. To investigate the allegation, on 11/15/2022 at 9:30 AM, LPA reviewed records, at 10:00 AM, LPA made observations during a physical plant tour, at 11:00 AM, LPA interviewed residents and at 1:00 PM, LPA interviewed staff. A review of the Department’s records revealed that the facility has not reported any Incident Reports involving any physical or verbal altercations recently. During a physical plant tour, LPA did not observe any physical or verbal altercations and did not hear any yelling. During interviews, all residents and staff stated that they have never witnessed or know of anyone who has had a physical altercation recently but S1, S6 and R5 stated that they have either heard or witnessed verbal altercations, arguments and yelling. Based on record reviews, observations and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time.

--- Female residents were inappropriately touched by male residents.

It was alleged that men inappropriately touch women. To investigate the allegation, on 11/15/2022 at 9:30 AM, LPA reviewed records, at 11:00 AM, LPA interviewed residents and, at 1:00 PM, LPA interviewed staff. A review of the Department’s records revealed that the facility has not reported any Incident Reports involving men inappropriately touching women. During interviews, all residents and staff stated that they have never witnessed or know of anyone that has touched a resident inappropriately. Based on record reviews and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time.

--- Facility food services are inadequate

It was alleged that the facility dismisses dietary restrictions and does not offer alternatives.
(Cont. on LIC9099-C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20221107155526

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: 11/15/2022

NARRATIVE

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To investigate the allegation, on 11/15/2022 at 10:50 AM LPA requested documents, at 11:00 AM, LPA interviewed residents and at 1:00 PM, LPA interviewed staff. A review of the facilities meal plan/menu revealed that the facility offers well-balanced and nutritious meals with alternatives for residents with dietary restrictions. During interviews, all residents and staff stated that they feel that the facility offers adequate meals that are well balanced. Furthermore, the Administrator stated that the facility offers alternative meals for those with dietary restrictions. Based on record reviews and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time.

No health and safety hazards noted during the visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC9099 (FAS) - (06/04)

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