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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 03/28/2025
Date Signed: 03/28/2025 02:54:54 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
03/24/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250324100753
FACILITY NAME:GOLDEN ASSISTED LIVINGFACILITY NUMBER:
197609621
ADMINISTRATOR:LOPEZ, MONIQUEFACILITY TYPE:
740
ADDRESS:14060 ASTORIA STTELEPHONE:
(818) 367-1947
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:128CENSUS: 119DATE:
03/28/2025
UNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Monique Lopez - AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not properly managing residents' medications
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose 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 10:43 AM, requested copies of facility documents relevant to the investigation at 11:12 AM, interviewed staff and residents between 11:15 AM to 1:30 PM and reviewed random residents' record between 1:30 PM to 2:30 PM. Regarding the allegation that Staff are not properly managing residents' medications, it was alleged that the Medication Office was found in disastrous conditions and was filled with unlocked medications. LPA's observation during physical plant tour revealed that the Medication Room itself was locked during visit, organized and in proper order. LPA's interview with the Lead medication technician and Administrator at around 11:30 AM, confirmed that the Medication Room is always locked and inaccessible to all residents. Medication pass is done in the dining room during meals (breakfast, lunch, and dinner). (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20250324100753
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: 03/28/2025
NARRATIVE
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(continued from LIC 9099)

Further interview revealed that if a resident is not present at the dining room, resident knocked on the medication room to get their medication. Moreover, if a resident has not taken own medication within the medication pass window, medication technician goes to the resident's room and administer the medication.

LPA's record review of twelve (12) random residents Medication Administration Record (MAR) revealed that twelve (12) out of twelve (12) residents MAR shows that all medication of each resident were given as prescribed. LPA's interview with twelve (12) residents or 10% of current census between 11:15 AM to 1:30 PM, revealed that twelve (12) out of twelve (12) residents were given their medication correctly and on time.

Based on the information gathered during this visit, the 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: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2