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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602062
Report Date: 02/28/2022
Date Signed: 02/28/2022 08:36:07 PM


Document Has Been Signed on 02/28/2022 08:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



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: 5DATE:
02/28/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Alba RuizTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted a Case Management visit to cite a deficiency identified during a separate Required 1-Year Annual Visit. LPA was granted entry by and identified himself to Staff #1 (S1) (see LIC 811 Confidential Names List for identification of S1). LPA then phoned Administrator Miguel "Michael" Malone, and licensee Alba Ruiz arrived later during the visit.

Staff #1 spoke Spanish but was not able to communicate in English. At the time, there were no other staff on duty to assist or translate for S1. Five of five residents in care did not speak Spanish and exhibited memory loss and disorientation; each was unable to converse with S1. It was necessary for LPA to use the Google Translate on a smart phone to communicate with S1. Even with this application, communication remained inefficient and less-than-accurate; residents in care were unable to benefit from it.

A deficiency was cited Per Title 22, Division 6, Chapter 8 of the California Code of Regulations (see LIC 809-D). Due to this deficiency being a repeat violation, a civil penalty of $250 was also assessed [see LIC421FC (7/17)]. An exit interview was conducted with Ruiz, to whom a copy of this report, the LIC 811, the LIC421FC, and the Licensee/Appeal Rights (LIC 9058 01/16) were provided via E-mail.

SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/28/2022 08:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: GOLDEN SUNSET RESIDENTIAL
FACILITY NUMBER: 374602062

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/30/2022
Section Cited

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Personnel Requirements – General: All personnel shall…have…(3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. The requirement is not met as evidenced by:
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Based on observation and interviews, S1 and residents were unable to communicate with each other. This posed a potential personal rights risk to 5 of 5 residents in care.
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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: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2022
LIC809 (FAS) - (06/04)
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