374602369-8-4-2020-08-AS-DPOL-BRZMXT-20200730100024

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 07/28/2020
Date Signed: 08/04/2020 10:24:09 AM

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
03/17/2020 and conducted by Evaluator Jennifer Lott

COMPLAINT CONTROL NUMBER: 08-AS-20200317102012

FACILITY NAME:	GOLDEN LIVING HEALTH MANAGEMENT, INC.		FACILITY NUMBER:	374602369
ADMINISTRATOR:	MNOYAN, MAYA S.		FACILITY TYPE:	740
ADDRESS:	3223 DUKE STREET		TELEPHONE:	(619) 222-1109
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92110
CAPACITY:	113	CENSUS: 70	DATE:	07/28/2020
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator, Maya Mnoyan		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Staff are not properly trained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Lott contacted the facility by telephone face time due to COVID-19, to deliver findings for the above allegation. LPA identified herself, explained the purpose of the call to Administrator, Maya Mnoyan. The Department’s investigation consisted of review of resident medical records, facility and staff files and interviews with staff. On or about 03/15/2020 it is alleged that NOC shift staff (2200-0600) were not properly trained to dispense medication.

Interviews and facility records revealed that there were four (4) staff on duty during the NOC shift; two (2) in the Memory Care Unit and two (2) in the Assisted Living Unit. Based on facility records and interviews, three (3) of the four (4) staff had received medication training and are able to dispense medication. Staff #4 has not administered any medication nor have they had medication training.

This agency has investigated the complaint alleging staff are not properly trained. The Department has found that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report, Appeal and Licensee Rights (LIC 9058 01/16) and confidential names (LIC 811) were provided to Administrator, Maya Mnoyan via email. An email read receipt confirms receipt.

This is an amended version of the original report created on 07/28/2020.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jennifer Lott	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2020

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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