197609621-12-12-2022-31-AS-RRAZ-CS4VL2-20230523163112

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 12/10/2022
Date Signed: 12/12/2022 08:06:15 AM

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: 119	DATE:	12/10/2022
		UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Marcelo Nogar		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff do not prevent residents from possessing illegal drugs in the facility
Resident's are required to maintain & complete the upkeep in the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst conducted a subsequent complaint visit to the faciity to conclude the investigation regarding the above allegation. LPA met with office staff, Marcelo Nogar, and advised him of the visit. During the course of the investigation, interviews and a physical plant inspection was made. Record reviews were also conducted. At approximately 9:00am to 11:00am, an inspection of the physical plant was made to insure the health and safety of the residents. The facility is a two story building, with a lower level/basement, an outdoor patio, and a large parking lot. From 11:00am to approximately 2:30pm, interviews and record review were conducted. The investigation is as follows:

Staff do not prevent residents from possessing illegal drugs in the facility:
In regards to the allegation, it was reported that some residents in the facility posses and distribute meth and illegal drugs in the facility. LPA conducted interviews with eight out of eight staff, who could not confirm the allegation. Interviews with ten out of ten residents also could not corroborate the allegation. A physical plant

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: 12/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2022

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: 12/10/2022

NARRATIVE

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inspection was made, checking random rooms and common areas for any evidence of drug usage or paraphernalia. LPA did not find any evidence during the investigation. Based on the information obtained during this investigation, there was insufficient evidence to prove that staff do not prevent residents from possessing illegal drugs in the facility. Therefore, the allegation is deemed Unsubstantiated at this time.

Resident's are required to maintain & complete the upkeep in the facility:
In regards to the allegation, it was reported that residents are required to maintain the facility and perform plumbing, gardening, housekeeping and provide care. Interviews with eight out of eight staff deny the allegation. No residents have been required to conduct any up keeping at the facility. Interviews with ten out of ten residents also deny the allegation that they have to maintain and keep the facility by gardening, plumbing, and housekeeping. LPA conducted a tour of the physical plant and did not observe any residents doing any maintenance, housekeeping or gardening during the day's investigation. Based on the information obtained, there was insufficient evidence to corroborate the allegation of the residents being required to maintain and upkeep the facility. 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: 12/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2022

LIC9099 (FAS) - (06/04)

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