198603164-3-20-2026-28-AS-WSHO-DVQVYJ-20260706165110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603164
Report Date: 03/13/2026
Date Signed: 03/20/2026 10:47:49 AM

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
02/22/2026 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260222203120

FACILITY NAME:	GOLDEN HAVEN GUEST HOME		FACILITY NUMBER:	198603164
ADMINISTRATOR:	VILLAVERDE, RICHARD		FACILITY TYPE:	740
ADDRESS:	706 E FOOTHILL BLVD		TELEPHONE:	(626) 334-7500
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	15	CENSUS: 10	DATE:	03/13/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Administrator Richard Villaverde		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Lack of staff supervision resulting in resident sustaining injury.

INVESTIGATION FINDINGS:

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The purpose of this Amended Report 3/20/2026 is to remove confidential information and remove
repeated statement.Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint visit to deliver findings pertaining to the above-mentioned allegation. LPA met with Administrator Richard Villaverde and explained the reason for the visit.
Today 3/13/2026 a collateral visit at 9:30 AM was conducted at Resident R1's Day Program. Resident R1 was interviewed shortly thereafter at 10:00 AM.
The initial visit was conducted on 2/27/2026 and included the following:
Licensing Program Analyst (LPA) Glenn Trueman conducted a complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Richard Villaverde and explained the reason for the visit.
At today's visit 2/27/2026 the following was done:
Resident and Staff Roster were submitted.
Files for Resident R1 and Resident R2 were reviewed.
Admission Agreement, Physician's Report and Individual Program Plan were submitted for Resident R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2026

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 3

Control Number 28-AS-20260222203120

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: 03/13/2026

NARRATIVE

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In regards to the allegation Lack of staff supervision resulting in resident sustaining injury, based on interviews conducted and information gathered Resident R1 stated that it was not staff who had pulled on R1's arm. Revealed that staff responded quickly when another resident had pulled on R1's arm. Said they jumped right in. Stated that R1 feels safe at the facility.
Spoke with Harbor Regional Service Coordinator who stated they were given information from the Day Program and on 2/17 the SIR was closed. Said on 2/18 R1 showed a bruise the size of a golf ball. 2/19 Stated that she called the Administrator and said the bruise looked a week old and was healing. The picture of the bruise looked small and old.

Information gathered from Day Program for Resident R2 which stated that R2 does have the behavior of pulling on other residents and the staff try to jump in, but R2 is quick and they get there ASAP. Will separate her from others.

Spoke with Administrator Richard Villaverde who stated that R1 and R2 have lived here 40 years without incident. Said R2 gets excited and pulls on residents arms. Stated R2 is just tapping, but other residents don’t like it. Administrator told R1 he will talk to R2 and also told staff to watch closely. Had staff also separate R1 and R2.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260222203120

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: 03/13/2026

NARRATIVE

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Spoke with Resident's R1-R6 who all stated that staff are very good. They reacted quickly to what the problem was. They moved R2 to a different location away from others.
R1 and R2 both stated they are treated well by staff.

Information gathered from R1's Day Program which stated that the bruise looked like it was healing and was not a fresh bruise.
Staff all stated that they have been watching closely all residents. Stated the Administrator told them to keep a close eye on R2 and behaviors R2 might act out on.
Said there has never been any abuse and R1 and R2 have been here 40 years and never a problem,.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED.

An exit interview was conducted with the Administrator. A copy of this report was given to the Administrator.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2026

LIC9099 (FAS) - (06/04)

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