197609621-4-10-2025-31-AS-TAGD-DGTSGG-20250519135155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 04/10/2025
Date Signed: 04/10/2025 02:48:21 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
03/03/2025 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20250303145417

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:	04/10/2025
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Monique Lopez - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Illegal eviction

Staff withheld resident's funds

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose 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 9:54 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that Resident #1 (R1) was illegally evicted, it was alleged that R1 was told to pack personal belongings to move out of the facility and was not given or issued an eviction letter. LPA's record review today revealed that R1 was a client of Los Angeles County Department of Health Services (LA DHS) through LA County Department of Mental Health Enriched Residential Care Housing (LA DMH ERC) and was the agency who transferred R1 to a six (6) bed facility. LPA's interview with the Administrator today revealed that R1 was the one who requested to be transferred to another facility. (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: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

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-20250303145417

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: 04/10/2025

NARRATIVE

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(continued from LIC 9099)

LPA's interview with R1's roommate today at 2:20 PM confirmed that it was R1 who wanted to leave ever since R1 came at the facility.

Regarding the allegation that Staff withheld resident's funds, it was alleged that R1 asked staff for own Personal and Incidental (P & I) monthly allowance of $177 but staff refused to provide it to R1. LPA's record review today revealed that R1 regularly get P & I allowance and signed for it every month, the last allowance R1 was given and signed for by R1 was on 03/06/25. LPA's record review of nine (9) other residents revealed that the facility always distributes on the 2nd or 3rd day of every month but R1 was hospitalized during these dates but was issued P & I money on the next Thursday upon R1's return to the facility on 03/03/25. LPA's interview with the Administrator revealed that if any resident missed the distribution of P & I on the 2nd or 3rd day of the month, the next distribution day is Tuesday or Thursday of the month following the original distribution dates. LPA's interview with nine (9) residents receiving P & I allowance at the facility, between 11:00 AM to 1:00 PM revealed that nine (9) out of nine (9) residents interviewed stated that they received their PNI on time and no staff withheld their P & I allowance.

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: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

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