197609621-6-27-2026-31-AS-TAGD-DXARJK-20260825130403

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 06/27/2026
Date Signed: 06/27/2026 03:02:59 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
03/04/2026 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20260304202236

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: 109	DATE:	06/27/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Amourfino Cruz - Staff		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not prevent resident from physically abusing another resident in care.

Staff mismanaged resident's medications.

Staff threatened resident.

Staff did not assist resident with relocation to a new facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with staff Amourfino Cruz and explained the reason for the visit.

LPA conducted a physical plant tour at 9:05 AM, requested copies of facility documents relevant to the investigation at 10:02 AM, reviewed records between 10:15 AM to 11:15 AM and interviewed staff and residents between 11:15 AM to 1:30 PM. Regarding the allegation that Staff did not prevent resident from physically abusing another resident in care, it was alleged that Resident #1 (R1) was being abused by another resident at the facility. LPA's interview with Resident #2 (R2) who is the long-time roommate of R1 while living at the facility today at 11:43 AM revealed that R2 did not witness anyone abusing R1 and denied abusing R1 at any time, R2 did not have any argument or any kind of altercation with R1 while they were roommates. Further interview with R2 also revealed that R1 was nice to everyone and had no enemy while living at the living at the facility. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2026

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-20260304202236

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: 06/27/2026

NARRATIVE

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(continued from LIC 9099)

LPA's interview with staff on 03/13/26 at 1:00 PM and today between 11:15 AM to 1:30 PM revealed that four (4) out of four (4) staff interviewed did not receive any information about R1 being abused by anyone.

Regarding the allegation that Staff mismanaged resident's medications, it was alleged that R1 may have been over medicated. LPA's record review revealed that R1 was given medication as prescribed for the months of February 2026 and March 2026. Further, laboratory results for R1's medication at that time did not cause R1 acute decline in motor function. LPA's interview with staff on 03/13/26 at 1:00 PM revealed while they were aware of R1's condition and upon the request of R1's third party provider, they couldn’t just stop the medication without the physician's order so they did request and eventually stopped the medication that may have caused R1 to limit motor functions.

Regarding the allegation that Staff threatened resident, it was alleged that the Administrator threatened R1 with eviction. LPA's interview with the Administrator on 03/13/26 at 1:00 PM revealed that the Administrator is well aware that R1 was a client of Department of Mental Health (DMH)-Enriched Residential Care (ERC) and they were the ones who can and may move R1 at any time. The administrator also stated that it was R1 who was requesting to move out to live on R1's own and denied threatening evicting R1 at any time.

Regarding the allegation that Staff did not assist resident with relocation to a new facility, it was alleged that R1 frequently requested assistance with relocation with the staff. LPA's interview with the Administrator on 03/13/26 at 1:00 PM revealed that R1 was a DMH-ERC and told R1 that the Administrator informed R1's Social Worker and would work with them so R1 could move to a place where R1 would like to live because they can't move R1 by themselves without the knowledge of DMH-ERC. R1 was successfully moved out of the facility on 04/02/26 by the DMH-ERC staff.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2026

LIC9099 (FAS) - (06/04)

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