197609621-8-11-2023-31-AS-MVAO-CWQULQ-20231018154108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 08/11/2023
Date Signed: 08/11/2023 02:56:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
04/19/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230419162022

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: 117	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Marilyn Nguyen - Licensee		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff sexually abused residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan and Mariana Agban conducted an unannounced subsequent complaint visit at this facility to deliver the finding for the above allegation. LPAs met with Licensee Marilyn Ngueyn and explained the reason for the visit.

On 04/19/23, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted by Community Care Licensing Division’s Investigation Branch (IB) and assigned to IB investigator Olivia Spindola. On 04/20/23 at 10:30 AM, then LPA Stamps initiated the complaint visit. LPA obtained copies of the facility records relevant to the investigation.

During the course of the investigation, Investigator Spindola interviewed the administrator of the facility where the former resident of this facility is currently residing. Investigator also interviewed the former resident of this facility and determined that a full investigation pertaining to the allegation was not warranted at this time. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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-20230419162022

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GOLDEN ASSISTED LIVING	FACILITY NUMBER: 197609621
	VISIT DATE: 08/11/2023

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation: staff sexually abused resident in care, it was alleged that a suspected group of paid individuals came into the room of Resident #1 (R1) once every month to rape (R1). LPA’s interview with the administrator on 05/17/23 at 1:30 PM revealed that R1 was a long-time former resident of this facility grandfathered in from the former owner but left sometime in 2018. LPA’s interview with the administrator of the facility where R1 is currently residing revealed that R1 was admitted at this facility on 09/11/2019.

Investigator Spindola’s interview with the administrator of the current facility of R1 on 05/16/23 at 1:00 PM revealed that R1 is currently taking medication for Schizophrenia, Dementia, Alzheimer's among other medical conditions. Furthermore, R1 has sent more than fifty (50) letters to multiple governmental agencies, private companies, and institutions requesting large sums of money believing that these entities owe R1 money.

Investigator Spindola’s interview with R1 on 05/16/23 at 1:40 PM revealed that R1 was not able to identify any person who allegedly raped R1 and was unable to provide any useful detail as to when, where and how the allegation happened. Rather, R1 states a more implausible allegation of being drugged while being raped by the Chief of Police, Firemen and rich people.

Based on the information gathered during the course of the investigation, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

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