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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 09/09/2022
Date Signed: 09/09/2022 04:41:25 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
09/01/2022 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20220901160320
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:
09/09/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator, Rocio GrandaTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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-Facility showers did not maintain hot water temperature
-Bathing facilities are not maintained in operating condition
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Administrator, Rocio Granda.

During today's visit, LPA briefly toured the facility, and interviewed staff and residents. It was alleged facility showers did not maintain hot water temperature. The hot water temperature for the shower in Room 41 was not maintained. LPA tested the hot water, which measured at 120 degrees F.. The hot water is not maintaining a consistent temperature and continued to rise up to 128 degrees F.. The cold water is not working properly to maintain a warm temperature, along with the hot water. The hot water was so hot that LPA had to pull their hand back from not getting burned. The shower does not maintain the regulated hot water temperature of 105-120 degrees F..

It was also alleged bathing facilities are not maintained in operating condition. The shower knobs in Room 41 are not operating correctly. The middle knob to turn the water to the top or bottom faucet is non operational. The hot and cold shower knobs are able to turn but do not function correctly by not adjusting the flow of the water. LPA was unable to turn the water off due to the faulty knobs and had to ask for assistance.

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.
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: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
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 2
Control Number 08-AS-20220901160320
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: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/10/2022
Section Cited
CCR
87303(e)(2)
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Maintenance and Operation.Water supplies and plumbing fixtures shall be maintained as follows:Faucets used by residents for personal care...shall deliver hot water. Hot water temperature controls shall be maintained...attain a temperature of not less than 105 degree F and not more than 120 degree F.
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Administrator stated they have a professional plumber at the facility today working on the plumbing. Administrator placed a warning a sign over the faucet indicating the hot water temperature. In addition, the administrator stated the plumbing will be resolved within 2 weeks and will send a copy of the receipt.
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This requirement is not met as evidenced by: Based on observations and interviews the licensee did not maintain faucets within regulation temperature for 1 out of 84 residents. This posed an immediate health and safety code risk
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Type B
09/16/2022
Section Cited
CCR
87303(a)
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Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Administrator stated the faucets will be replaced and a copy of the receipt will be sent by POC due date.
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This requirement is not met as evidenced by: Based on observations and interviews the licensee did not maintain the bathroom shower faucets in operating condition for 1 out of 84 residents. This posed a potential 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: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2