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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 09/20/2023
Date Signed: 09/20/2023 04:25:49 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
11/03/2021 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20211103150253
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: 90DATE:
09/20/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Business Office Assistant, Ruth GrandaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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-Resident medications not given as prescribed
-Resident had accessibility to items that pose a danger
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 Business Office Assistant, Ruth Granda.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and outside sources. It was reported medications were not given as prescribed for two residents, Resident #1 (R1) and Resident #2 (R2). Interviews with facility staff confirmed the facility managed R1 and R2’s medications. It was reported R1’s medications were not being taken and found stored in R1’s drawer by R1. Staff interviews revealed not being aware of any medications in R1’s possession. R1’s Medication Administration Record (MAR) dated 06/01/21-07/04/21 reflected staff signatures for all dates, which indicated the medications were dispensed. Staff interviews revealed R1 was alert and able to ask for medications and request refills, there were no medication errors for R1. It was also reported R2 was not receiving their evening medications. Continued on an LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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 5
Control Number 08-AS-20211103150253
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: 09/20/2023
NARRATIVE
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A review of R2’s MARs dated 06/23/22-07/22/22 indicated eleven (11) different medications were not given to include nineteen (19) missed doses. Also, R2’s Insulin was not given for the entire month as prescribed for morning or bedtime. Facility staff interviews revealed the medication technicians were not correctly documenting the MARs. Facility staff also stated R2 administered their own insulin but was unable to state why the MAR did not reflect the insulin was provided. A review of R2’s MARs reflected medications were not given as prescribed.

It was also alleged that R1 had accessibility to items that pose a danger. It was reported R1 had a knife and fork under their pillow and loose medications in their drawer. Administrator’s interview revealed a knife and fork were confiscated from R1’s drawer. However, there were no medications observed in the drawer. It was unknown how R1 obtained the knife and fork. Once made aware of the items the administrator had the items immediately removed.

Based on interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8, are 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 Business Office Assistant, Ruth Granda whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1 and Resident #2]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20211103150253
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: 09/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2023
Section Cited
CCR
87465(a)(4)
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Incidental Medical and Dental Care. A plan for incidental medical...shall be developed by each facility. The plan shall encourage routine medical...such care, by compliance with the following: The licensee shall assist residents with self-administered medications as needed.
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Business Office Assistant, Ruth Granda agreed to have staff attend medication training and provide proof of training by POC due date.
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This requirement is not met as evidenced by:
Based on record review and interviews the licensee did not ensure medications were given as prescribed for 1 out of 79 residents in care [R2], which posed a potential health and safety risk.
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Type B
10/18/2023
Section Cited
CCR
87309(a)
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Storage Space. Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
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Business Office Assistant, Ruth Granda agreed to have staff attend training on storing items that could pose a danger and provide proof of training by POC due date.
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Based on interviews the licensee did not items that pose a danger were inaccessible to 1 out of 79 residents in care [R1], which posed a potential health and safety risk.
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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.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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
11/03/2021 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20211103150253

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: 90DATE:
09/20/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Business Office Assistant, Ruth GrandaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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-Lack of supervision resulting in injury
-Staff did not provide incontinent care, resident sustained a rash
-Licensee did not assist or arrange medical care for resident
-Staff did not safeguard resident's personal items
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 Business Office Assistant, Ruth Granda.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and outside sources. It was alleged that lack of supervision resulted in Resident #1 (R1) sustaining an injury of a broken bone. Evidence obtained during the investigation revealed R1 fell at the facility on 07/01/21 and was found by staff. First aid was provided to R1, along with an offer to receive medical attention from the hospital. However, R1 refused medical care, didn’t complain of pain, and stated they had a future appointment with their Primary Care Physician on 07/06/21. R1’s medical records indicated R1 was seen in the emergency room on 07/03/21 and diagnosed with a broken wrist from a previous fall, two (2) days prior, 07/01/21. R1’s Physician’s Report dated 03/21/20 indicated R1 was non-ambulatory and able to independently toilet. Continued on an LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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-20211103150253
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: 09/20/2023
NARRATIVE
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R1’s Resident Appraisal dated 03/23/20 indicated R1 used a walker, needed assistance with bathing, grooming, toileting, medication management, and night supervision. R1’s Functional Capability Assessment dated 03/23/20 indicated R1 used a walker and needed help with bathing, dressing, and toileting.
Staff interviews revealed R1 was able to toilet independently and R1’s family bought R1 depends as a preventative measure. Outside source interviews confirmed R1 was able to toilet independently. Additional outside source interviews revealed there were no concerns for the broken wrist as R1 had an accidental fall, while independently using the restroom. It was also alleged staff did not provide incontinent care and R1 sustained a rash. R1’s records indicated R1 required assistance with incontinence care. However, interviews revealed R1 was able and did toilet independently. A review of R1’s medical records for 07/03/21 reflected R1’s skin was negative for rash. In addition, the medical records did not identify depends/diapers being worn or skin breakdown due to incontinence. Outside source and staff interviews confirmed R1 was able to toilet independently.

It was also alleged the licensee did not assist or arrange medical care for R1 for approximately one (1) year. Outside source interviews stated there was an assumption R1 did not receive medical treatment due to being in the locked memory care unit. However, all residents have the right to medical care regardless of location within the facility. R1’s spouse was the Durable Power of Attorney (DPOA) and assisted R1 with their medical appointments. Outside source interviews revealed the DPOA had complete control and did not allow R1’s family members to be involved with the medical care. The administrator’s interview revealed R1 received appropriate medical care, which was monitored by the DPOA. The DPOA made R1’s appointments and took R1 to them. R1 also had a lot of virtual medical visits due to Covid-19. R1 had their own cell phone in their room and would contact their physician on their own. R1 knew how to call in their own medication refills and discuss them with their physician. A review of R1’s records indicated R1 had multiple scheduled medical appointments to include visit documentation.

Lastly, it was alleged the staff did not safeguard R1’s personal items regarding fans. Client/Resident Personal Property and Valuables form was completed for R1. There were multiple items listed. However, there were no fans indicated on the form. The administrator stated the facility provided fans to residents during the hot weather and was not aware of any missing fans.

During the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Business Office Assistant, Ruth Granda whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5