336403755-2-14-2023-18-AS-EMAN-CPXU96-20230315152235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403755
Report Date: 02/14/2023
Date Signed: 02/14/2023 11:57:03 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/04/2022 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220104164250

FACILITY NAME:	GOLDEN CARE SENIOR LIVING ON RAMSEY		FACILITY NUMBER:	336403755
ADMINISTRATOR:	PENDING		FACILITY TYPE:	740
ADDRESS:	3863 WEST RAMSEY		TELEPHONE:	(951) 849-7521
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	0	CENSUS: 0	DATE:	02/14/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Administrator Maria Jasmin Dolores		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility failed to properly meet resident's medical concerns

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown arrived at the facility 02/14/2023 at 09:20 AM unannounced to conclude a complaint investigation regarding allegation listed above. LPA Brown met with Administrator Maria Jasmin Dolores. Business Office Liason Kristine Juarez was contacted and informed of the visit.

The investigation included residents and staffs interviews and file reviews. Based on interviews and records review conducted, LPA Brown cannot find evidence to corroborate the allegation. Resident interviews indicated staffs are always available to assist residents and constantly provide care and supervision to all the residents in care and staffs are addressing all their medical concerns immediately. Staff interviews indicated that they all provide care and supervision to all the residents in care and if they observed a resident needs medical attention or if a resident has a medical concern, they immediately help the resident and assist on providing the appropriate care. LPA Brown reviewed Resident # 1 (R1) Progress Notes and it revealed that staffs observed R1’s medical concern and immediately assessed and helped R1 then staff called 911 for R1 to be transported to the hospital. *** Continuation in LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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 18-AS-20220104164250

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: GOLDEN CARE SENIOR LIVING ON RAMSEY	FACILITY NUMBER: 336403755
	VISIT DATE: 02/14/2023

NARRATIVE

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Per records review, LPA Brown observed the facility’s in constant communication to R1’s Physician and R1 had regular visits to R1’s Physician. Moreover, LPA Brown reviewed documentation that facility reported the incident to R1’s responsible party and to the Community Care Licensing Division (CCLD). There are no witnesses or medical documentation to corroborate the allegation of Facility failed to properly meet resident's medical concerns.

Based on the information obtained there is not enough evidence of allegation of Facility failed to properly meet resident's medical concerns. therefore, the allegation is deemed UNSUBSTANTIATED at this time. 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.

An exit interview was conducted with Administrator Maria Jasmin Dolores, where this report (LIC 9099) were discussed and provided.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

LIC9099 (FAS) - (06/04)

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