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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609621
Report Date:
11/10/2021
Date Signed:
11/10/2021 02:46:09 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
Wendell Smith
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:
106
DATE:
11/10/2021
UNANNOUNCED
TIME BEGAN:
11:30 AM
MET WITH:
Monique Lopez
TIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident's personal items
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced initial complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit.
LPA conducted a physical plant walk through of the facility from 11:30-11:45am.
Staff did not safeguard resident's personal items
It is alleged that staff stole resident #1 (R1) refrigerator and when R1 got it back it was broken. LPA conducted an interview with R1 and the administrator. LPA went to R1's room and observed R1's refrigerator to be working fine. Administrator stated that no one has ever taken R1's refrigerator or had it sold to anyone else. R1 stated that the refrigerator is working fine. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/10/2021
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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