366427602-1-17-2024-56-AS-NBRN-D2DTWC-20240212140517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366427602
Report Date: 01/17/2024
Date Signed: 01/17/2024 02:29:14 PM

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
01/08/2024 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240108114146

FACILITY NAME:	GOLDEN YEARS RESIDENTIAL CARE		FACILITY NUMBER:	366427602
ADMINISTRATOR:	ALEXANDRU POPESCU		FACILITY TYPE:	740
ADDRESS:	7890 SAN BENITO STREET		TELEPHONE:	(909) 335-8335
CITY:	HIGHLAND	STATE: CA	ZIP CODE:	92346
CAPACITY:	6	CENSUS: 4	DATE:	01/17/2024
		UNANNOUNCED	TIME BEGAN:	10:49 AM
MET WITH:	Rosie Gaxiola, staff		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Licensee does not ensure staff are able to communicate with residents in care.
Licensee does not ensure staff possess knowledge of good nutrition, food preparation and, menu planning.
Staff yelled at residents in care.
Staff speaks inappropriately in front of residents.
Staff did not ensure resident was accorded personal privacy while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Anna Bueno and Bianca Wolcott conducted an unannounced visit to the facility to initiate the investigation of the above mentioned allegations and deliver findings. LPAs identified themselves to Staff 1 (S1) and Staff 2 (2) who were informed of the reason for today’s visit. S1 notified administrator Iren Creighton of LPA's visit. The investigation included interviews with relevant parties, made facility observations, and reviewed records.

Allegation 1: Licensee does not ensure staff are able to communicate with residents in care. LPAs observed S1 and S2 on shift. LPAs interviewed residents who stated that they are able to communicate their needs to staff. LPAs interviewed S1 and S2 who gave adequate responses to LPAs.
Allegation 2: Licensee does not ensure staff possess knowledge of good nutrition, food preparation and, menu planning. Resident interviews revealed that staff provide nutritious meals. LPAs observed various fresh and frozen nutritive food items, such as green vegetables, potatoes, dairy, and meat. Interview wit
h S1 revealed that some residents have food restrictions that they follow and that S2 only serves meals. S1 interview found that

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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 56-AS-20240108114146

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 YEARS RESIDENTIAL CARE	FACILITY NUMBER: 366427602
	VISIT DATE: 01/17/2024

NARRATIVE

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S1 and other staff prepare meals and that some meals are prepared early then frozen to be reheated on days that only S2 is working.
Allegation 3: Staff yelled at residents in care. Interviews with residents revealed that staff do not yell at them nor have residents heard other staff yell at other residents. Staff interviews deny yelling at residents and have not observed other staff yell at other residents. LPAs observed S1 and S2 raise their voice when speaking with some residents due to residents being hard of hearing. Witness (W1) interview deny hearing staff yell at residents.
Allegation 4: Staff speaks inappropriately in front of residents. Resident interviews deny that staff spoke inappropriately or use improper language towards residents. Staff interviews deny speaking ill to residents or observing any staff speak inappropriately to residents. W1 interviewed deny hearing staff speak inappropriately.
Allegation 5: Staff did not ensure resident was accorded personal privacy while in care. LPAs observed that Room 1 is a shared bedroom with a divider in the middle of the room. LPAs observed that the facility has cameras in common areas. Interview with W1 state that staff appeared to be passing through facility common areas without pausing or stopping and denied that staff stayed in the same area with W1. Staff interviews deny recording or taking photos of any residents.

Based on the information revealed during the investigation, these allegations are therefore unsubstantiated. A finding of UNSUBSTANTIATED means, 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. An exit interview was conducted with and a copy of this report was provided to Rosie Gaxiola.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC9099 (FAS) - (06/04)

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