197609621-12-3-2022-31-AS-RRAZ-CS4VL3-20230523163113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 12/03/2022
Date Signed: 12/03/2022 04:12:44 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
11/04/2021 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20211104100914

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: 115	DATE:	12/03/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Amourfino Cruz		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff does not insure a comfortable temperature in the facility
Staff doesn not provide resident with sufficient linens
Resident had access to a sharp object

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to investigate the above allegations. LPA met with staff, Amourfino Cruz, and advised him of the allegations. During the course of the investigation, interviews, record review and a physical plant inspection were made. At approximately 9:15am to 11:30am, a physical plant inspection conducted on the first and second floors of the facility, 11:30am-2:00pm, interviews were made with residents and staff.

Staff does not insure a comfortable temperature in the facility:
In regards to the allegation, it was reported that the internal temperature of the facility is maintained cold year round. On warmer days, the temperature is even "cranked up" to high. During the course of the visit, LPA conducted a physical plant inspection of the first and second floors. LPA observed the temperature guage in the hallways and common areas maintained between 74-76 degrees. According to staff, the thermostat in the hallways are designated to control the temperture of three resident rooms. When a

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2022

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-20211104100914

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: 12/03/2022

NARRATIVE

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resident expresses that it is too hot, or too cold, it is adjusted by staff to insure the residents in the three rooms have a comfortable room temperature. Interviews with ten of ten residents reveal no complaints regarding the internal temperature being maintained at an uncomfortable level. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not insuring a comfortable temperature in the facility. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff does not provide resident with sufficient linens:
In regards to the allegation, it was reported that when Resident 1 (R1) requested for clean towels, staff refused. Interviews with staff reveal that housekeeping is maintained once a day. As part of the housekeeping task, linens, beddings and towels are changed. Staff adds that if requested, residents are never denied a new set of towels. It is also provided per request. Interviews with ten of ten residents do not corroborate the allegation of not being provided sufficient linen. LPA checked the facility supply and observed a sufficient supply of clean bedding, linen and towels, kept in the linen closet on the first and second floors for the residents use. Based on the information obtained, there was insufficient evidence to prove that staff does not provide residents with sufficient linens. Therefore, the allegation is deemed Unsubstantiated at this time.

Resident has access to a sharp object:
In regards to the allegation, it was reported that on or around November 2021, a facility resident was observed walking around with a sword. The report received to this complaint did not identify a resident by name. Interviews with staff deny the allegation. Interviews with ten of ten residents also do not confirm that this allegation had occurred. Based on the information obtained, there was insufficient evidence to corroborate the allegation of a resident observed walking around the facility with a sword. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2022

LIC9099 (FAS) - (06/04)

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