374602369-10-30-2023-08-AS-MVAO-CXEV62-20231109150849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 10/30/2023
Date Signed: 10/30/2023 04:01:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
08/13/2020 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20200813143233

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: 94	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yahaira Garduno Med Tech Supervisor		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff mishandles resident's medication.
Staff did not provide a comfortable room temperature for resident.
Facility is in disrepair.
Facility is not free of insects.
Facility does not provide adequate food service for resident.
Resident's room does not have sufficient lighting.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced complaint visit to deliver investigative findings. LPA identified herself and was invited into the facility. LPA met with Administrator, Rocio Granda and Yahaira Garduno Med Tech Supervisor and shared findings.
The Department investigated the above-listed complaint allegations. The investigation consisted of an inspection of the facility, interviews with staff and outside sources, and a review of resident and facility records relevant to this investigation.

On August 13, 2020 Community Care Licensing (CCL) received a complaint alleging that facility staff mishandles resident's medication. Resident 1 (R1) records were reviewed and there were no discrepancies or mishandling of medication. Resident 2 (R2) records were reviewed and there were no discrepancies or mishandling of medication. Resident 3 (R3) records were reviewed and there were no discrepancies or mishandling of medication. Outside Source 1 (OS1) was interviewed and there were no concerns regarding medication and was not aware of any mishandling of medications.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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-20200813143233

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GOLDEN LIVING HEALTH MANAGEMENT, INC.	FACILITY NUMBER: 374602369
	VISIT DATE: 10/30/2023

NARRATIVE

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(Continue from LIC9099)

It was alleged that staff did not provide a comfortable room temperature for resident. LPA Domingo toured the facility and the ambient temperature was 68 to 70 degrees Fahrenheit. During the tour the residents that were observed were well groomed. The temperature outside of the main building was 73 degrees Fahrenheit and one resident had a light jacket and a hat. It was observed all residents in care were clean, well-groomed, and appropriately dressed. There was shade provided and all residents observed were comfortable. OS1 was interviewed and had no complaints regarding room temperature for the residents.

It was alleged that the Facility is in disrepair. LPA Domingo toured the facility and observed no rooms or community areas that was in disrepair. The dinning room, activities room, resident rooms were observed to be clean, no odors, no dirty linens or clothes on the floor. The facility tour showed no disrepair. OS1 was interviewed and there have been no concerns regarding disrepair of the facility.

It was alleged that the Facility is not free of insects. LPA Domingo toured the facility and observed no rooms or community areas with insects. The residents’ rooms and accommodations were observed to be clean, free from clutter, and malodor free. The dinning room, activities room, resident rooms were observed to be clean, no odors, no dirty linens or clothes on the floor and no insects. The facility tour showed no insects. OS1 was interviewed and there have been no concerns regarding insects in the facility.

It was alleged that the Facility does not provide adequate food service for resident. According to management, they have never experienced a shortage of food as groceries are delivered every week and more often if needed. R1, R2 and R3 stated that they had no concerns with the quantity, availability and quality of food provided at the facility. During interviews, the residents indicated they liked the food and that the food portions were sufficient to meet their needs. OS1 was interviewed and had no concerns regarding the facility food service.

Continued on LIC9099C

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200813143233

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GOLDEN LIVING HEALTH MANAGEMENT, INC.	FACILITY NUMBER: 374602369
	VISIT DATE: 10/30/2023

NARRATIVE

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Continued from LIC9099C

It was also alleged that Resident's room does not have sufficient lighting. LPA Domingo toured the facility and observed no rooms or community areas that did not have sufficient lighting. The dinning room, activities room, resident rooms were observed to have sufficient lighting. The facility tour showed no disrepair or lights. OS1 was interviewed and there have been no concerns regarding insufficient lighting.

The Department has investigated the above-mentioned allegations and has found that based upon interviews, record reviews, and observations, there was insufficient evidence to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, these allegations are deemed to be unsubstantiated.

An exit interview was conducted with Med Tech Yahaira Garduno to whom a copy of this report, along with Licensee Rights (LIC 9058 03/22), were provided at the conclusion of the visit.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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