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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603164
Report Date: 04/24/2026
Date Signed: 04/24/2026 02:30:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2026 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20260417110525
FACILITY NAME:GOLDEN HAVEN GUEST HOMEFACILITY NUMBER:
198603164
ADMINISTRATOR:VILLAVERDE, RICHARDFACILITY TYPE:
740
ADDRESS:706 E FOOTHILL BLVDTELEPHONE:
(626) 334-7500
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:15CENSUS: 10DATE:
04/24/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Richard VillaverdeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff hit resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Administrator Richard Villaverde and explained the reason for the visit.

During today’s visit, LPA obtained a copy of the resident and staff rosters, reviewed R-1’s file and obtained relevant documentation, interviewed Administrator Staff 1 (S1) - Staff 4 (S4), SC from SGPRC and interviewed Resident 1(R1) - Resident 3 (R3).

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2026
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 28-AS-20260417110525
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GOLDEN HAVEN GUEST HOME
FACILITY NUMBER: 198603164
VISIT DATE: 04/24/2026
NARRATIVE
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Allegation: Staff hit resident. It was alleged that facility morning staff, who assisted with the medication, hit R1 and R1 was crying.

LPA interviewed the Administrator and Staff. Administrator stated that was unaware of what had happened until Police Officer from Azusa Police Department arrived and informed about the incident that allegedly happen on 04/16/26. Police Officer came to the facility twice, on 04/16/26 and 04/17/26 for wellness check and interviewed R1 and staff. The Police Officer gave a case number with no report. Copy of Police case number was provided to LPA. The administrator stated an internal investigation was conducted. Administrator interviewed all residents including R1 and staff. The administrator stated that residents and staff denied that staff hit R1. Administrator indicated that when they asked R1 if any staff hit them, R1 claims that S1 hit them. When Administrator asked how it happened, R1 cannot explain or give details of what happened. R1 changed the topic and started to cry saying that they missed their family. During today’s visit, LPA interviewed S1 who denied hitting R1 or other residents. Also S1 stated that they not assisting with R1’s morning medications. Other staff interviewed did not witness S1 hitting R1 or any other residents. They stated they treat residents with respect and would not hit a resident. R1 was interviewed and responded yes that someone hit them but mentioned name which not listed on the facility staff roster. However, R1 could not provide any details regarding incident. Interviewed residents indicated they have not been hit by anyone and have not observed S1 or any other staff hitting R1 or other residents. Interviewed Administrator, staff and residents mentioned that R1 often cries for no reason, but sometimes R1 tells them that they missed their family. At the time of visit LPA collected and reviewed documentation pertaining to R1, including IPP ( Individual Program Plan). Per IPP R1 exhibits emotional outbursts (crying) about one or two times a week without any reason. LPA spoke with R1's Service Coordinator who indicated R1's medical diagnosis could contribute to R1 crying often; as well as R1 missing their mother. SC stated that they don't have any concerns about R1 at this time.

Based on record / file review and interviews conducted, investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted with the Administrator and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2