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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 05/18/2022
Date Signed: 05/19/2022 02:32:13 PM

Substantiated


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
03/18/2022 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20220318165203
FACILITY NAME:GOLDEN LIVING HEALTH MANAGEMENT, INC.FACILITY NUMBER:
374602369
ADMINISTRATOR:ROCIO GRANDAFACILITY TYPE:
740
ADDRESS:3223 DUKE STREETTELEPHONE:
(619) 222-1109
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:113CENSUS: 84DATE:
05/18/2022
UNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Administrator, Rocio GrandaTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Facility staff did not ensure that resident's medication was refilled in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the complaint investigation regarding the above mentioned allegations. LPA met with Administrator, Rocio Granda.

During the investigation, LPA briefly toured the facility, obtained records, and interviewed staff and residents. It was alleged the facility did not ensure Resident #1’s (R1) medication was filled in a timely manner. R1’s Physician’s Report indicated R1 is able to store and manage their own medications. Staff interviews revealed R1 has requested the facility manage their medications for R1. Facility records revealed R1 did not receive two (2) medications timely in February 2022 and one (1) medication in March 2022. Further staff interviews revealed the facility calls in the refills for R1’s medications and R1 picks them up. Facility’s Medication Administration Record for February 2022 reflected R1 was not given a medication on 02/06/22 and 02/07/22, R1 missed two (2) doses of that medication. Also, another medication was not given on 02/27/22 and 02/28/22, R1 missed two (2) doses of that medication. Continued on an LIC 9099C


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
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 5
Control Number 08-AS-20220318165203
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: 05/18/2022
NARRATIVE
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Staff interviews revealed that medication was ordered by the facility on 02/22/22 and ready for pick on 02/25/22, however, R1 did not pick it up timely. Staff interviews also revealed the medication not given on 02/27/22 & 02/28/22 were due to R1 not picking up the medication refill, once it was ready for pick up. Facility staff was unable to state why the medications were not obtained for R1 once it was discovered the medications were ready for pick up and R1 was missing doses.

Facility’s Medication Administration Record for March 2022 reflected R1 was not given one (1) medication for a period of five (5) days. R1’s medication was not received timely in March 2022 due to miscommunication of refill. Staff interviews revealed in March 2022, R1 decided to use Kaiser Pharmacy delivery service, which is by mail and takes 3-5 days for mail delivery. Therefore, due to R1 calling in the refill on their own and not alerting facility staff caused a delay of R1 receiving their medication through the delivery service. R1 confirmed ordering refill through the mail delivery service causing the delay of that medication. Once the facility had knowledge R1 was not given their medication but aware the refill was ready, no assistance was provided to R1 to obtain the refill timely. In addition, R1 did not receive medications as prescribed for a total of nine days between the three different medications in February and March 2022. The licensee did not ensure R1 received their medications timely, as prescribed.



Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated due to the Resident not receiving medications timely as prescribed. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20220318165203
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/19/2022
Section Cited
CCR
87465(a)(4)
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Incidental Medical and Dental Care - The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:
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Administrator agreed to conduct In-Service training regarding medication management and ensuring all residents receive their medications as prescribed and timely. Administrator will provide proof of scheduled training by POC due date and submit proof of training within 2 weeks.
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Based on interviews and record review, the licensee did not ensure one (1) out of 84 residents received their medications timely. R1 went without medications for a total of 9 days. This poses an immediate health and safety risk to 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: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/18/2022 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20220318165203

FACILITY NAME:GOLDEN LIVING HEALTH MANAGEMENT, INC.FACILITY NUMBER:
374602369
ADMINISTRATOR:ROCIO GRANDAFACILITY TYPE:
740
ADDRESS:3223 DUKE STREETTELEPHONE:
(619) 222-1109
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:113CENSUS: 84DATE:
05/18/2022
UNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Administrator, Rocio GrandaTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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-Residents room not large enough to allow for easy passage between beds
-Staff interfering with resident having reasonable access to telephone
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the complaint investigation regarding the above mentioned allegations. LPA met with Administrator, Rocio Granda.

During the investigation, LPA briefly toured the facility, obtained records, and interviewed staff and residents. It was alleged resident rooms are not large enough to allow for easy passage between beds. It was reported Resident #1’s (R1) and Resident #2 (R2) share a bedroom and both use wheelchairs. LPA observed the bedroom was large enough to accommodate furniture and two wheelchairs. Resident interviews revealed one of the two residents does not store their wheelchair properly next to their bed, which can allow obstruction in the room. Resident interviews also revealed the two residents used to be friends and are no longer friends. Therefore, they no longer want to share the bedroom. Staff interviews revealed the bedroom is large enough to accommodate both wheelchairs and furniture. However, the residents no longer want to reside together, which is causing disruption between the two residents. Administrator’s interview revealed both residents were aware of wheelchair use and the size of the bedroom, and both requested to live together. Administrator stated now that the residents are no longer friends issues between the two were starting to arise. Continued on an LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20220318165203
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: 05/18/2022
NARRATIVE
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It was also alleged staff were interfering with resident having reasonable access to telephone. It was reported R1 was told by a staff member to hurry up and get off the phone because others have to use the phone. The facility has a designated phone area with a land line telephone, table and chair for resident use. The facility also has a cordless telephone that the residents can use for more privacy. Resident interviews revealed there is no time frame to use the telephone and staff do not tell residents to get off the phone. Further resident interviews revealed R1 uses the land line for hours at a time and there was one occasion R1 was asked to allow other residents to have a turn. However, it was nicely stated by staff. Resident interviews revealed denial of staff asking them to hurry up and get off but stated other residents will make those statements to other residents on the phone. Staff interviews revealed the residents are allowed to use the phone whenever they like and there are no time frames. Staff interviews also revealed denial of telling R1 to hurry up and get off the phone. Administrator’s interview revealed the facility has a land line and cordless phone for resident use. Administrator stated the residents are able to access the phone whenever they like and for as long as they like. Administrator stated she has never heard a staff member tell a resident to get off the phone but has heard other residents make comments to one another about phone use.

Based on interviews and observations, the investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. Therefore, the allegations were determined as unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1 and Resident #2]

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5