306006417-7-30-2026-22-AS-KSGH-DWHUDL-20260731152940

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006417
Report Date: 07/30/2026
Date Signed: 07/30/2026 03:54:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
06/29/2026 and conducted by Evaluator Hanna Gough

COMPLAINT CONTROL NUMBER: 22-AS-20260629151439

FACILITY NAME:	GOLDEN YEARS GROUP		FACILITY NUMBER:	306006417
ADMINISTRATOR:	ATTRAH, AMEER		FACILITY TYPE:	740
ADDRESS:	507 S. CITADELL LANE		TELEPHONE:	(657) 221-3232
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92806
CAPACITY:	6	CENSUS: 5	DATE:	07/30/2026
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Ameer Attrah		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff kicked resident.

INVESTIGATION FINDINGS:

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Licensing Program analyst (LPA) Hanna Fuller made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegation. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Ameer Attrah and discussed the purpose of the visit.

The investigation into the facility allegation of staff kicked resident revealed the following: It was alleged that Staff #1 (S1) kicked Resident #1 (R1) after they fell onto the floor when transferring with S1s assistance. LPA reviewed a preplacement appraisal for R1 dated October 30, 2025, stating that R1 needs assistance when transferring in and out of bed. This was signed by R1 and facility staff. LPA reviewed a physicians report for R1 dated October 29, 2025, stating that R1 does not walk and is non-ambulatory due to their physical condition. This report was signed and dated by a medical professional.

LPA interviewed 5 of 5 residents in care including R1 and 3 of 5 residents denied the allegation. 1 of 5 residents did not confirm or deny the allegation. Continue on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026

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 22-AS-20260629151439

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GOLDEN YEARS GROUP	FACILITY NUMBER: 306006417
	VISIT DATE: 07/30/2026

NARRATIVE

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Interviews with R1 revealed that S1 was trying to put them to bed before R1 wanted to go to bed and S1 tipped the wheelchair over causing R1 to land on the floor. R1 informed LPA that S1 kicked them twice on their hip area, but did not leave any bruises. R1 informed LPA that they do not have proof of the incident occurring due to there being no witnesses.

LPA interviewed 2 of 2 staff and 2 of 2 staff denied the allegation.

LPA reviewed 2 of 2 staff having a signed Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders.

S1 had documentation of annual training being conducted with care giver personal rights training on file.

Based on information gathered and interviews conducted, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation are deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was left at the facility.

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026

LIC9099 (FAS) - (06/04)

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