374602369-3-20-2024-08-AS-LTEZ-D3QVYC-20240326165053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 03/19/2024
Date Signed: 03/20/2024 08:20:12 AM

Unsubstantiated

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
03/12/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240312090659

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: 88	DATE:	03/19/2024
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Medication Technician, Andrea Rodriguez		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulted in resident altercation
Staff verbally abused resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Natasha Persaud conducted a complaint investigation regarding the above-mentioned allegations. LPA met with Administrator, Rocio Granda, However, she had to tend to an urgent matter. Therefore, Medication Technician, Andrea Rodriguez completed he visit with LPA.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and residents. It was alleged lack of supervision resulted in a resident altercation. It was reported Resident #1 (R1) was asleep in their room when Resident #2 (R2) came into R1’s room and hit R1, while they were asleep. R1’s interview revealed that R1 used to live in a shared room with R2 when the altercation occurred back in November 2023. Today, R1 expressed they were not concerned about the previous altercation because the facility acted appropriately, and the police were contacted. R1 did not press charges or sustain any injuries. LPA confirmed R1 has resided in a private room for over one year and there were no altercations in November 2023 between R1 and R2. R1 admitted there was no lack of supervision at the time of the altercation due to the residents being roommates. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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-20240312090659

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: 03/19/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The facility relocated R1 to a private room to ensure their safety. The previous altercation was addressed and resolved years ago. Staff interviews revealed there have been no recent altercations between R1 and R2, and R1 resides in a private room.

It was also alleged staff verbally abused resident. It was reported Staff #1 (S1) called R1 a curse word on 03/10/24. It was reported R1 was waiting outside for a pizza delivery, when S1 verbally abused R1. S1 was sitting in their car when R1 approached the vehicle assuming it was the delivery person. However, once R1 approached the vehicle, it was S1. R1 stated S1 told them to leave as they’re not allowed in the street. S1 stated they told R1 they needed to leave as S1 couldn’t be around R1. S1 elaborated by stating there were previous issues between S1 and R1, which was also confirmed by R1. Staff interviews confirmed that R1 was waiting for a pizza delivery and mistook S1’s car but no curse words were exchanged. Resident interviews revealed there have been some issue between R1 and S1, but no curse words were witnessed on 03/10/24. Both staff and the resident that witnessed R1 and S1 on 03/10/24 denied S1 called R1 a curse word. The administrator explained the previous issues between R1 and S1 occur during the NOC shift when there are no other individuals to corroborate the concerns. The facility will be switching S1’s schedule from NOC shift to AM shift as a precautionary measure. The administrator expressed she wants to ensure all residents are treated with dignity and if there are any issues they can be observed and resolved. The administrator has not witnessed S1 curse at R1 and the incident was also not reported to her.

During the course of 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 03/22) were provided to Medication Technician, Andrea Rodriguez whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1 and Staff #1]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2