197609621-9-20-2024-31-AS-TAGD-DABSGP-20241023135215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 09/20/2024
Date Signed: 09/20/2024 02:25:03 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
04/02/2024 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20240402133640

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:	09/20/2024
		UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Monique Lopez - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff allowed residents to smoke inside the facility

Residents were not provided nutritious meals

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 9:22 AM, requested copies of facility documents relevant to the investigation at 10:11 AM and interviewed residents and staff between 10:30 AM to 1:15 PM. Regarding the allegation that Staff allowed residents to smoke inside the facility, it was alleged that residents were allowed to smoke inside the facility because R1 smoked in facility restroom at times. LPA's record review today at 10:14 AM today revealed that the on the admission agreement of the facility includes a copy of the house rules wherein all residents, upon admission was informed and sign the house rules wherein it specifically stated that smoking inside the facility is strictly prohibited. LPA's interview with three (3) residents on 04/05/24 between 10:30 AM to 1:00 PM and nine (9) residents today between 10:30 AM to 1:15 PM or 10% of the current census. (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: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

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-20240402133640

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: 09/20/2024

NARRATIVE

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(continued from LIC 9099)

Revealed that twelve (12) out of twelve (12) residents interviewed did not witness or see any resident smoking inside the facility. LPA's interview with the administrator

Regarding the allegation that Residents were not provided nutritious meals, it was alleged that Residents were fed mainly hot dogs and other unhealthy foods. LPA's observation during visit on 04/05/24, 05/17/24, 06/11/24 and today revealed that the facility served a variety of foods which almost always include soup, vegetable, meat and fruit on every meal. LPA's record review of facility menu confirmed that the facility served variety of foods with meat, fruit and vegetables on every meal. LPA's interview with three (3) residents on 04/05/24 between 10:30 AM to 1:00 PM and nine (9) residents today between 10:30 AM to 1:15 PM or 10% of the current census, revealed that eleven (11) out of twelve (12) residents interviewed believe that the food being served are nutritious and healthy.

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.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

LIC9099 (FAS) - (06/04)

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