198603573-8-8-2026-28-AS-FFIS-DWY2GC-20260814172255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603573
Report Date: 08/08/2026
Date Signed: 08/08/2026 03:14:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
05/02/2025 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250502102030

FACILITY NAME:	GOLD MEDAL SENIOR LIVING GARDENS		FACILITY NUMBER:	198603573
ADMINISTRATOR:	SANTOS, TONI		FACILITY TYPE:	740
ADDRESS:	311 NORTH MOUNTAIN AVE		TELEPHONE:	(714) 488-7542
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	6	CENSUS: 5	DATE:	08/08/2026
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Adrian Colores		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Due to lack of supervision, resident fell and sustained an injury.
Staff did not ensure resident's bathroom met the resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 08/08/2026 regarding the above allegations, to deliver findings. On 05/09/2025, LPA Ramirez conducted an initial complaint investigation visit and a need for further investigation was documented. During today’s visit LPA Ramirez was greeted by Caregiver- Adrian Colores and explained the purpose of the visit. LPA Ramirez was provided House Manager- Victoria Serna’s telephone number and was asked to contact Serna to discuss LPA’s visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Copy of Resident#1 (R1): Medical Assessment, Identification and Emergency Information, Hospice care plans, staff interviews#1-6 (S1- S6), resident interviews# 1-3 (R1- R3), attempted interview of resident# 4-6 (R4-R6) and physical plant tour.

See 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2026

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 28-AS-20250502102030

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GOLD MEDAL SENIOR LIVING GARDENS	FACILITY NUMBER: 198603573
	VISIT DATE: 08/08/2026

NARRATIVE

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The investigation revealed the following: regarding the allegation “Due to lack of supervision, resident fell and sustained an injury.” It is alleged that due to a lack of supervision, R1 fell and sustained a new injury. Six (6) out of the six (6) staff interviewed denied this allegation. Staff interviews revealed that R1 could walk independently with a walker but had several falls the first week R1 arrived at the facility. Staff interviews revealed that staff checked on R1 every 1 to 2 hours, placed a fall mat beside R1’s bed, used a baby monitor to listen for when R1 needed assistance and contacted R1’s hospice care team after each fall. Review of R1’s medical records did not corroborate that R1 sustained a new injury as a result of a fall at the facility. Three (3) out of the three (3) residents interviewed denied this allegation. Resident interviews revealed that staff provides sufficient supervision. Due to cognitive abilities R4-R6 interviews were unreliable. 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.

“Staff did not ensure resident's bathroom met the resident's needs.” It is alleged staff did not ensure R1’s bathroom met R1’s needs. Six (6) out of the six (6) staff interviewed denied this allegation. Three (3) out of the three (3) residents interviewed denied this allegation. On 05/09/2025, LPA Ramirez interviewed R1 and demonstrated to LPA how R1 gains entry into their private bathroom. LPA observed R1 use their walker to walk into their private bathroom without difficulty. LPA Ramirez observed grab bars near R1 toilet and near the shower. 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. No deficiencies were cited during this visit. A copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2026

LIC9099 (FAS) - (06/04)

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