197609621-7-24-2023-31-AS-TAGD-D7ZHPZ-20240810062305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 07/24/2023
Date Signed: 07/24/2023 03:40:35 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
07/20/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230720082501

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:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Marilyn Nguyen - Licensee		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not safeguard resident's belongings

Staff do not assist resident with bathing and grooming

Staff do not maintain facility clean and sanitary at all times

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegations. LPA met with licensee Marilyn Nguyen and explained the reason for the visit.

LPA conducted physical plant tour at 9:21 AM, requested copies of facility documents relevant to the investigation at 9:49 AM and interviewed staff and residents between 10:10 AM to 1:30 PM. Regarding the allegation that Staff did not safeguard resident's belongings, it was alleged that Resident #1 (R1)'s laptop, cellphone, clothing and wallet are missing at the facility. LPA's record review today at 1:30 PM revealed that R1 only declared laptop and guitar on Resident's Personal Property and Valuable (LIC 624) and LPA observation during physical plant tour at about 9:30 AM confirmed and located the laptop, guitar and cell phone in R1's room.

(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: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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-20230720082501

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: 07/24/2023

NARRATIVE

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(continued on LIC 9099)

Regarding the allegation that Staff do not assist resident with bathing and grooming, it was alleged that staff do not assist R1 with bathing and grooming, resulting in the resident having some medical issues. LPA's record review today revealed that R1 was able to bathe, dress/groom and care for own toileting needs. LPA's interview today with Resident #2 (R2) who is R1's room mate for about a year revealed that R1 bathe, dress and groom on R1's own and able to take care of R1's own toileting needs. LPA's interview with care staff today at 12:00 PM also confirmed that R1 was able to do everything on R1's own and never asked for any assistance from them.

Regarding the allegation that Staff do not maintain facility clean and sanitary at all times, it was alleged that staff do not clean residents' bedrooms, nor clean the facility hallway. LPA's observation today at 9:35 AM revealed that all the common rooms are clean and in proper order. LPA's visited seven (7) random rooms including R1's room and observed that all the seven (7) room visited were clean and in proper order. LPA's interview with twelve (12) residents or more than 10% of the current census revealed that twelve (12) out of twelve (12) residents interviewed stated that the facility is being clean regularly on a daily basis including their bedrooms.

Based on the information gathered during this visit, the allegations are 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: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

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