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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003718
Report Date: 11/16/2022
Date Signed: 11/29/2022 07:15:58 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2022 and conducted by Evaluator Lydia Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220124084542
FACILITY NAME:ISHASH GOLDEN HOMESFACILITY NUMBER:
306003718
ADMINISTRATOR:NOEL MOSQUEDAFACILITY TYPE:
740
ADDRESS:516 S. JENSEN WAYTELEPHONE:
(714) 526-9202
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:6CENSUS: 0DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Noel MosquedaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility mismanaged resident's funds
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lydia Martinez delivered findings via telephone and emailed report to former Licensee/Administrator Noel Mosqueda. Ishash Golden Homes closed on 11/3/2022.

During the course of the investigation, interviews were conducted with staff, a review of resident records was completed and copy of pertinent documents were obtained such as Physician’s Report, Preplacement Appraisal, Admission Agreement, Appraisal Needs and Service.

Resident 1 (R1) was a resident of Ishash Golden Homes since 01/20/2020. R1 was own responsible party and signed all documents themself when R1 moved into the facility. On October 16, 2020, R1 appointed a “Special Power of Attorney” to manage R1’s funds, bills, etc. R1 passed away on 01/15/2022.

(cont...LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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 22-AS-20220124084542
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ISHASH GOLDEN HOMES
FACILITY NUMBER: 306003718
VISIT DATE: 11/16/2022
NARRATIVE
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Per the Reporting Party (RP), was told that R1 had outstanding bills and that RP needed to pay the facility since RP was the beneficiary. RP was told R1 could not pay the facility for several months and that the facility had to pay for R1’s medication in the amount of $1800 since 05/2021. RP stated there were several checks missing when RP received R1’s belongings. RP agreed to send LPA Martinez copies of R1’s bank statements but never did. The RP has not been billed but was told verbally regarding the funds owed to the facility.

LPA Martinez spoke to Licensee/Administrator (L/A) Noel Mosqueda who denied the allegation and stated R1 managed own funds up until October 2020 when R1 appointed a POA. Facility did not manage R1’s funds at anytime while living at the facility; therefore, had no records or knowledge of R1’s finances. L/A Mosqueda stated he was not aware of any funds owed to the facility and/or billing any POA or resident. LPA Martinez attempted to contact R1’s POA but had no success.

Due to insufficient information, LPA is unable to corroborate allegation of “Facility mismanaged resident’s funds”. Therefore, the allegation is deemed Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report was provided via email to former Licensee/Administrator Mosqueda.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
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