374602369-5-20-2022-08-AS-DPOL-CEXRKM-20220531130547

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 05/20/2022
Date Signed: 05/20/2022 12:08:14 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, 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
10/27/2021 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20211027112238

FACILITY NAME:	GOLDEN LIVING HEALTH MANAGEMENT, INC.		FACILITY NUMBER:	374602369
ADMINISTRATOR:	ROCIO GRANDA		FACILITY TYPE:	740
ADDRESS:	3223 DUKE STREET		TELEPHONE:	(619) 222-1109
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92110
CAPACITY:	113	CENSUS: 82	DATE:	05/20/2022
		UNANNOUNCED	TIME BEGAN:	11:54 AM
MET WITH:	Monica Cordoba, Manager Assistance		TIME COMPLETED:	12:12 PM

ALLEGATION(S):

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Staff did not protect resident resulting in resident to be humiliated.
Staff restricted resident’s right to associate with another resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegation. LPA was granted entry to the facility by Monica Cordoba, Manager Assistance, after identifying herself and explaining the reason for the visit.

On October 27, 2021, it was alleged that the facility’s staff did not protect a resident from name-calling resulting in the resident being humiliated and that facility staff restricted a resident’s right to associate with another resident. The Department’s investigation consisted of review of facility records and interviews of facility staff and outside sources.

[Continued on LIC9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther Miller	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

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 08-AS-20211027112238

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 LIVING HEALTH MANAGEMENT, INC.	FACILITY NUMBER: 374602369
	VISIT DATE: 05/20/2022

NARRATIVE

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[Continued from LIC9099]

During the week of October 10, 2021, it was alleged that Resident 1 (R1) was called a "pedophile" by Resident 2 (R2), who was reported to be intoxicated. R1 reported this incident to the Administrator who sent a staff member to speak with R2 about the incident. Facility records show that R2 was given an eviction notice December 6, 2021 due to breaking house rules regarding alcohol. Facility records also show that R2 has a history of being verbally aggressive to other residents and caregivers. Staff interviews and outside source interviews about the incident did not reveal new information not provided by facility records. Evidence obtained does not support the allegation that facility staff did not protect resident resulting in resident to be humiliated.

During the week of October 10, 2021, R1 attempted to have a meal with Resident 3 (R3) in R1’s room. It was alleged that staff prevented R3 from eating in R1’s room. Facility records included an incident report, written by Staff 1 (S1), stating that on October 24, 2021, R1 requested for R3 to eat in R1’s room. The document did not indicate that staff prevented this, but only reported it. Staff interviews revealed that the incident was documented merely because of how unusual the situation was, since R3 usually ate in the dining room. S1 denied refusing R3 from eating in R1’s room; in fact, S1 remembered two trays brought to R1’s room and two empty trays being taken out of R1’s room indicating that R3 did in fact eat in R1’s room during the time in question. R3 confirmed that they ate with R1 during the month of October 2021 and that staff did not prevent this. Evidence obtained does not support the allegation that facility staff prevented residents from associating with each other.

Based on the evidence obtained during the complaint investigation, the allegations that the facility’s staff did not protect a resident from name-calling and that facility staff restricted a resident’s right to associate with another resident is found to be UNSUBSTANTIATED. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Monica Cordoba, Manager Assistance; a copy of this report, Licensee's Rights (LIC9058), and LIC9099-C were provided to Manager Assistance.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther Miller	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

LIC9099 (FAS) - (06/04)

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