197609621-1-22-2025-31-AS-TAGD-DJSLTE-20250721090208

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 01/22/2025
Date Signed: 01/22/2025 02:38:37 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
01/16/2025 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20250116134118

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: 121	DATE:	01/22/2025
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Monique Lopez - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not provide comfortable accommodations to residents in care

INVESTIGATION FINDINGS:

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

LPA conducted physical plant tour at 9:22 AM, requested copy of facility documents relevant to the investigation at 9:49 AM and interviewed residents and staff between 10:00 AM to 1:00 PM. Regarding the allegation that Staff did not provide comfortable accommodations to residents in care, it was alleged that only cold air was coming out of the heating unit. LPA's observation during physical plant tour at 9:22 AM revealed that the facility has the heater on and LPA could feel the heater along the hallway and all the random rooms visited on both floors. Further, all the thermostats were set in between 72°F to 78°F during visit. LPA's interview with the administrator at 11:30 AM revealed that each thermostat covers four (4) rooms and they adjust it based on their residents' need. Further, the administrator admitted that they got a complaint yesterday (01/21/25) from a resident that the heater was not working. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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-20250116134118

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: 01/22/2025

NARRATIVE

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(continued from LIC 9099)

Administrator checked the rooms and already placed a work order for that cluster of rooms. LPA observed that the technician arrived today at around 12:10 PM and proceeded to the roof to diagnose and do the repair. LPA's interview with Resident #1 (R1) who complained to the administrator confirmed that R1 only noticed the heater the day before and reported it immediately to the administrator. It was also alleged that the television in the lobby has been broken for several months and the facility's WI FI has been turned off or not working. LPA's records review between 1:00 PM to 1:45 PM revealed that the service provider for both TV and internet are the same and there were outages during the wildfire. LPA's interview with the administrator revealed that the TV in the lobby has never been broken and had only outages due to severe weather. LPA's interview with twelve (12) residents between 10:00 AM to 1:00 PM today revealed that twelve (12) out of twelve (12) residents stated that there were times that the television and internet were not working but only for about a week or so about two (2) weeks ago, which coincide with the wildfire timeline.

Based on the information gathered during this visit, this allegation is 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: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC9099 (FAS) - (06/04)

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