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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602062
Report Date: 06/16/2023
Date Signed: 06/16/2023 02:29:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/26/2021 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20210326102438
FACILITY NAME:GOLDEN SUNSET RESIDENTIALFACILITY NUMBER:
374602062
ADMINISTRATOR:MIGUEL A MALONEFACILITY TYPE:
740
ADDRESS:7541 MILKY WAY POINTTELEPHONE:
(619) 794-2889
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:6CENSUS: 2DATE:
06/16/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Maricela Vega-Delgado, CaregiverTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Facility does not have telephone service
INVESTIGATION FINDINGS:
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It was also alleged that the facility does not have telephone service. On 6/16/2023, at about 12:00 PM, LPA visited the facility unannounced. LPA was met by Caregiver, Maricela Vega-Delgado who, after LPA introduced himself and explained the purpose of the visit, allowed LPA into the facility. On the day of the visit, LPA obtained and reviewed facility records and verified that the facility telephone had service and was working.

The Department's investigation into this allegation consisted of outside source, staff and resident interviews and LPA observation. During the virtual visit to the facility on 4/1/2021, facility staff informed LPA that the facility telephone service had been disconnected one week prior to the visit. Additionally, through direct observation, LPA observed and determined that none of the alternate telephone numbers provided by the facility had voice mail set up.

Based on LPA direct observation and staff interviews, there is sufficient evidence to prove that the facility did not have telephone service. Therefore, the allegation is Substantiated.

A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Caregiver, Vega-Delgado to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
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 08-AS-20210326102438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GOLDEN SUNSET RESIDENTIAL
FACILITY NUMBER: 374602062
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2023
Section Cited
CCR
87311
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Telephones. All facilities shall have telephone service on the premises. This requirement was not met as evidenced by: Based on LPA observation and staff interviews, the facility did not have telephone service on the premises. This posed a health and safety risk to 5 out of 5 residents in care.
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On 6/16/2023, LPA confirmed by direct observation, the facility now has telephone service. Administrator Malone agreed to activate the facility voice mail and provide direction to all staff requiring them to answer the facility telephone. Administrator will submit written proof to CCLD including staff’s initials and date the direction was received by the POC due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2