207209150-12-3-2021-24-AS-SPIY-C9KLWU-20211210080743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 207209150
Report Date: 12/03/2021
Date Signed: 12/03/2021 02:35:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/07/2021 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20210907120810

FACILITY NAME:	GOLDEN YEARS RESIDENTIAL CARE HOME, THE		FACILITY NUMBER:	207209150
ADMINISTRATOR:	LUARES, BERNARDINO		FACILITY TYPE:	740
ADDRESS:	160 S 13TH STREET		TELEPHONE:	(707) 235-2717
CITY:	CHOWCHILLA	STATE: CA	ZIP CODE:	93610
CAPACITY:	41	CENSUS: 39	DATE:	12/03/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Elizabeth Luares-Prasad - Licensee		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are refusing to take the resident back into care.

INVESTIGATION FINDINGS:

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2
3
4
5
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7
8
9
10
11
12
13

On this date, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to deliver complaint findings. LPA met with Licensee Elizabeth Laures-Prasad and discussed the purpose of the inspection.

During the course of the investigation, the Department conducted interviews, reviewed records, and inspected the facility. On 9/5/2021, Resident 1(R1) was admitted to the hospital. Hospital staff contacted the facility in order to discharge R1 back to the facility during early morning hours. The licensee coordinated with the responsible party for R1 in order to have R1 discharged back to their home at the wish of the responsible party. The above allegation is Unfounded. No deficiencies were cited during the inspection. Exit interview conducted. A copy of the report was provided to the licensee via email.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021

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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