197609621-9-28-2023-31-AS-TAGD-D7ZHPY-20240810062304

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 09/28/2023
Date Signed: 09/28/2023 03:06:02 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: 116	DATE:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Monique Lopez - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff do not allow resident to receive phone calls at the facility
Staff do not provide resident with bed linen
Staff do not meet resident's dietary needs
Staff did not properly supervise resident, resulting in resident sustaining an injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with administrator Monique Lopez and explained the reason for the visit.

LPA conducted physical plant tour at 9:43 AM, requested copies of facility documents relevant to the investigation at 10:12 AM and interviewed residents and staff between 10:30 AM to 1:25 PM. Regarding the allegation that Staff do not allow resident to receive phone calls at the facility, it was alleged that staff do not allow Resident #1 (R1)'s family member speak to R1. LPA's observation during visit on 07/24/23 at 9:30 AM revealed that R1 owned a cell phone and kept on R1's drawer. LPA's interview with Resident #2 (R2) on 07/24/23 at 10:30 AM revealed that R1 used own phone every now and then. LPA's interview with the administrator also revealed that whenever the office received a phone call for a resident, they page and locate the resident and bring to the office to use the phone, if unable to locate, they ensure to pass the message to the resident, if there is any. (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: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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: 09/28/2023

NARRATIVE

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Further, LPA's interview with twelve (12) residents or more than 10% of the current census revealed that eight (8) of the residents interviewed had their own cell phone and twelve (12) out of twelve (12) residents did not have any problem with the facility receiving their phone calls.

Regarding the allegation that Staff do not provide resident with bed linen, it was alleged that R1 was not provided bed linen by the staff. On 07/24/23 at around 10:30 AM, LPA observed that the bed of R1 was made and had a clean linen. Also, during that visit, LPA's interview with R2 (R1's room mate) revealed that staff regularly change their linen once a week or if there is any accident, they change it immediately. LPA's interview with staff today revealed that they changed bed linens of every resident a minimum of once a week and immediately if there are "accidents" or if the linen is wet. LPA's interview with twelve (12) residents or more than 10% of the current census revealed that twelve (12) out of twelve (12) residents stated that their bed linens are changed at least once a week by the staff.

Regarding the allegation that Staff do not meet resident's dietary needs, it was alleged that staff do not feed R1 three (3) meals a day. LPA’s interview with R2 (R1's room mate) revealed that R1 eats regularly in the dining room three (3) times a day. LPA's interview with care staff confirmed that R1 regularly went to the dining room to eat meals and never requested tray service. LPA's interview with twelve (12) residents or more than 10% of the current census revealed that twelve (12) out of twelve (12) residents stated that the facility serve meals three (3) times a day at the dining room.

Regarding the allegation that Staff did not properly supervise resident resulting in resident sustaining an injury, it was alleged that R1 was attacked by a former roommate injuring R1's leg. LPA's record review today at 1:30 PM revealed that there was no record of R1 injuring own leg at any time while living at this facility. LPA's interview with the administrator today also revealed that she did not receive any report of R1 being attacked by a room mate during R1's stay at the facility. LPA's interview with R2, R1's last room mate, revealed that R2 gets along with R1 and there was no time that they had any altercation or argument. Further interview with the administrator also revealed that the former room mate of R1 prior to R2 left the facility on 03/24/2023.

Based on the information gathered during this and prior 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: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC9099 (FAS) - (06/04)

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