374602369-3-22-2023-08-AS-LTEZ-CQFSRA-20230331140601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 03/22/2023
Date Signed: 03/22/2023 05:28:55 PM

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
10/21/2021 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20211021152316

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: 86	DATE:	03/22/2023
		UNANNOUNCED	TIME BEGAN:	03:31 PM
MET WITH:	Business Manager, Monica Cordoba		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee did not meet the needs of a resident

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA), Natasha Persaud concluded the complaint investigation regarding the above mentioned allegation. LPA met with Business Manager, Monica Cordoba.

During the investigation, the facility was toured, records reviewed, and interviews conducted with staff, resident, and outside sources. It was reported Resident #1’s (R1) needs are not being met regarding their medical care. R1 has been making statements they were going to die. R1 resided in the memory care unit and was able to handle some of their activities of daily living, with reminders. R1’s spouse/responsible party confirmed R1 had no plans to end their life, had no means to end their life, and would not hurt themselves in any way. R1’s spouse/responsible party also indicated R1 does not express suicidal ideations. R1’s Physician’s Report dated 06/02/21 indicated R1 was ambulatory and able to self-care for bathing, dressing/grooming, and feeding and has confusion due to a Major Neurocognitive Disorder. It also indicated, R1 was not aggressive but has depression without suicidal/self-abuse. R1’s Resident Appraisal dated 06/24/21, reflected R1 was ambulatory and required assistance with bathing supervision; assistance with dressing; special diabetic diet; and medication management. Continued LIC9099C.

Unsubstantiated

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: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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 2

Control Number 08-AS-20211021152316

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: 03/22/2023

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

R1’s interview revealed they were sad and wanted to move back home. R1 also disclosed wanting their family members to visit more. R1 denied suicidal ideations. Administrator’s interview revealed R1 was sad and complained they wanted to go home and wanted their spouse to visit more often. The administrator explained the spouse can visit any time they like. However, the spouse comes to the facility to pick R1 up for medical appointments and is unable to stay long to visit, which is upsetting to R1. The administrator stated she reached out to R1’s spouse and family members requesting they visit more.

R1’s spouse/responsible party was in charge of R1’s medical care and took R1 to all of their medical appointments. R1’s spouse/responsible party reported having difficulty obtaining all required care for R1 due to not having conservatorship over R1. R1’s spouse/responsible party’s interview revealed the facility is meeting R1’s needs, the issues were not with the facility but with R1’s physicians. R1’s physician’s would not provide details for R1’s care due to the spouse not having conservatorship. The spouse/responsible party also revealed R1 was treated by multiple Psychiatrists and Neurologists and nothing was accomplished. R1 continued to receive proper medical treatment but their spouse was unable to obtain proper details of the care to provide to the facility. The facility was unable to obtain any medical information for R1, due to not having authority, as that responsibility was delegated to R1’s spouse/responsible party. R1’s family member reported R1 was sad because their life was turned upside down when R1 went to live in the facility, after living in their own home and providing for their own needs. R1’s family member also confirmed the administrator reached out to the family and asked them to visit R1 more often. R1’s family member believed the facility was meeting R1’s needs and the issues were with R1’s spouse/responsible party. Staff interviews revealed R1 expressed they were sad and wanted their spouse to visit. However, the spouse was always too busy to visit but was able to take R1 to all their medical appointments. Staff also divulged there was nothing dangerous in the memory care unit for R1 to harm themselves with. Additional staff interviews confirmed R1 was not suicidal and did not make any statements to suggest suicide.

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 01/16) were provided to Business Manager, Monica Cordoba whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2