315002894-6-6-2023-59-AS-LMUZ-CSTNRY-20230615104218

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002894
Report Date: 06/06/2023
Date Signed: 06/06/2023 01:31:22 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/01/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20230601160353

FACILITY NAME:	GOLDEN HILLS CARE HOME		FACILITY NUMBER:	315002894
ADMINISTRATOR:	MAHAJAN, VIVEK		FACILITY TYPE:	740
ADDRESS:	1434 ELM STREET		TELEPHONE:	(916) 474-4920
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95678
CAPACITY:	6	CENSUS: 4	DATE:	06/06/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Vivek Mahajan		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee allows staff to work without criminal record clearance.
Staff do not have required immunizations.
Staff do not receive required training prior to providing care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Talwinder Bains and Lavinia Muscan arrived at the facility unannounced on 06/06/23 to do complaint investigation for above allegations. LPAs met with administrator Vivek Mahajan and explained the purpose of the visit.

The department did facility record review and staff interviews for complaint investigation.

***report continue on LIC9099C.......

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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 59-AS-20230601160353

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: GOLDEN HILLS CARE HOME	FACILITY NUMBER: 315002894
	VISIT DATE: 06/06/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

***report continued from LIC9099......

Allegation- Licensee allows staff to work without criminal record clearance.
The department did facility record review and staff interviews for complaint investigation. Staff interviews indicated that all staff associated with facility have criminal record clearance and no staff were working at facility without criminal record clearance. Administrator interview indicated that facility was aware about this requirement and they do not allow any staff working at the facility without criminal record clearance. Record review for all staff files showed that all staff working at the facility were fingerprint cleared and associated with facility, therefore this allegation is UNFOUNDED.

Allegation- Staff do not have required immunizations.
The department did facility record review and staff interviews for complaint investigation. Facility record review indicated that facility staff have all required immunization which staff need to have upon hiring per their physician. Also, CCL does not have any current guidelines regarding staff immunization to work at any licensed facility , therefore this allegation is UNFOUNDED.

Allegation- Staff do not receive required training prior to providing care.
The department did facility record review and staff interviews for complaint investigation. Facility staff record review indicated that facility staff have all the required training per department guidelines except for 2 staff members who start working with facility since 05/16/23. Per CCL regulation 87412.c.1 ,facility have 4 weeks time to finish the required on boarding training with staff from their hiring date so facility will finish all required training for those 2 staff members till 06/16/23 and notify department once completed, therefore this allegation is UNFOUNDED.

Based on the investigation, the preponderance of evidence standards has not been met. Therefore, the above all allegations is found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

No citations were issued today. Exit meeting conducted with administrator.
A copy of this report has been provided to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2