374602369-12-21-2022-08-AS-LTEZ-CMJRGW-20221228120124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 12/20/2022
Date Signed: 12/21/2022 09:27:24 AM

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
11/17/2022 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20221117105339

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: 83	DATE:	12/20/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator, Rocio Granda		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility is retaining a resident that requires a higher level of care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud concluded the complaint investigation regarding the above mentioned allegation. LPA met with Administrator, Rocio Granda.

During the course of the investigation, the facility was toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged the facility is retaining Resident #1 (R1), who requires a higher level of care. R1’s Physician’s Report dated 12/13/21 indicated R1 has Diabetes and requires insulin injections along with blood sugar checks. The physician’s report reflected R1 is unable to administer their own medications, conduct blood sugar checks and has uncontrolled diabetes due to noncompliance. R1’s Resident Appraisal dated 10/17/22 indicated R1 required medication management but is able to handle their other activities of daily living. Outside source interviews revealed R1’s diabetes is not controlled because R1 is unable to manage their own diabetes medications. Outside source interviews also revealed R1 draws their own insulin from the container and measures it incorrectly, therefore, R1 is not receiving the correct dose to manage their diabetes. Continued on an LIC 9099C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

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-20221117105339

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: 12/20/2022

NARRATIVE

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Additional outside source interviews revealed witnessing R1 measure their insulin incorrectly on multiple occasions as well as unable to check their own blood sugar. The facility manages R1’s medications, they do not log R1’s blood sugar checks. The administrator’s interview revealed not being aware of a change in condition or that staff were assisting with injections. Staff interviews revealed R1 was observed drawing the incorrect dose of insulin on multiple occasions and shakes a lot, which makes it difficult for R1 to administer their own injections safely. The facility does not have a skilled professional on staff to administer the injections. Staff stated they were not aware the resident must administer their own injections, or it must be conducted by a skilled professional. Staff admitted R1 is unable to manage their blood sugar checks or administer their insulin independently and agreed R1 required a higher level of care due to the facility not having a skilled professional on staff to assist. Facility staff interviews revealed denial or R1 having a change in condition but admitted R1 shakes a lot and does not draw the proper amount of insulin. R1 is unable to administer their own insulin injections and check their own blood sugar, independently. R1 requires a higher level of care, where a skilled professional can administer R1’s insulin and blood sugar checks.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. 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 Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20221117105339

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: 12/20/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/17/2023 Section Cited CCR 87628(a)	1 2 3 4 5 6 7	Diabetes. The licensee shall be permitted to accept or retain...diabetes if the resident is able to perform his/her own glucose testing with blood...is able to administer his/her own medication...administered orally or through injection, or has it administered by an appropriately skilled professional.	1 2 3 4 5 6 7	Administrator stated she will find placement for R1 by POC cue date. Administrator stated they do not have a skilled professional on staff, therefore, they will do Hand over Hand to ensure R1 is receiving the correct dose safely and administering it themselves.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews, the licensee retained (R1) 1 out of 83 resident’s that required assistance with diabetic medication management and no skilled professional on staff to assist with injections. This posed a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

LIC9099 (FAS) - (06/04)

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