197609621-8-15-2024-31-AS-TAGD-D8YN7L-20240910101256

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 08/15/2024
Date Signed: 08/15/2024 11:24:28 AM

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
01/31/2023 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230131095157

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: 123	DATE:	08/15/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Monique Lopez		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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1. Staff had sexual relations with resident in care
2. Staff provided beer and marijuana to resident in care
3. Staff financially abused resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Monique Lopez and informed her the purpose of the visit. On 01/31/2023, the Woodland Hills Regional South Adult and Senior Care Office received a complaint for the allegations mentioned above and referred it to the Community Care Licensing Division’s (CCLD’s) Investigations Branch (IB). It was assigned to Investigator Lorraine Patterson, to investigate and determine the finding for allegation # 1. LPA Tuesday Cabiness investigated allegations # 2 and # 3. The following was determined:

Allegation # 1: It was alleged that staff had sexual relations with resident in care. On 02/01/2023, LPA Abeye Duguma, conducted a physical plant inspection, interviews, and obtained documents pertaining to the complaint. Investigator Patterson conducted additional interviews, obtained, and reviewed documents pertaining to allegation #1 on various dates, from approximately February 2023 through April 2023. The following was determined: Resident # 1 (R1) and staff # 1 (S1) both denied having a sexual relationship while at the facility. Interviews by staff denied witnessing or having any information of a relationship between R1

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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-20230131095157

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: 08/15/2024

NARRATIVE

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and S1. Further information revealed, R1 and S1 did have a personal relationship; but not until R1 relocated and moved from the facility and out of state and S1 was no longer working at the facility, and it was consensual from both. IB Patterson revealed there is no corroborating evidence to prove sexual abuse while in care, therefore based on interviews, the allegation is Unsubstantiated.

Allegation # 2: It was alleged that staff provided beer and marijuana to resident in care. To investigate the allegation, on 02/01/2023 at 11am LPA Abeye Dugma, conducted a physical plant inspection, interviewed staff, and obtained documents pertaining to the allegation. On August 08, 2024, from 945am to 2pm, LPA Tuesday Cabiness conducted additional interviews with staff and residents, as well as obtained documents. It was revealed to LPA, that no one witnessed staff # 1 (S1) giving resident # 1 (R1) drugs or alcohol, and it was reported that residents do not use drugs while at the facility. Based on interviews, there is sufficient evidence to prove the allegation, therefore, the allegation is Unsubstantiated at this time.

Allegation # 3: It is alleged that staff financially abused resident in care. To investigate the allegation, on 02/01/2023 at 11am LPA Abeye Dugma, conducted a physical plant inspection, interviewed staff, and obtained documents pertaining to the allegation. On August 08, 2024, from 945am to 2pm, LPA Tuesday Cabiness conducted additional interviews with staff and residents, as well as obtained documents. It was reported to LPA, that Brilliant Corners paid resident # 1 (R1’s) rent and sent the balance of (R1's) money to the facility for (R1). Administrator also reported to LPA, that she disbursed all residents’ funds twice a week, and (R1) was observed to be given their funds. LPA was not able to interview (R1) or (S1) who both are no longer living or working at the facility. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

An exit interview was conducted and a copy of this report was given.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC9099 (FAS) - (06/04)

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