374602369-4-18-2024-08-AS-LTEZ-D4PQBG-20240426120131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 04/18/2024
Date Signed: 04/18/2024 09:41:23 PM

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
04/11/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240411093448

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: 92	DATE:	04/18/2024
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Staff, Adilene Ramirez		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Lack of supervision resulted in resident wandering out of facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the above-mentioned allegation. LPA met with Administrator, Rocio Granda and Staff, Adilene Ramirez.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, resident, and outside sources. It was alleged lack of supervision resulted in a resident wandering out the facility. On 04/07/24, Resident #1 (R1) left the facility and went to the McDonald’s located down the street. R1 sustained a fall and the paramedics responded and transported R1 to the hospital. R1 did not sustain any injuries. R1’s Physician’s Report dated 02/08/24 indicated R1 was confused and not allowed to leave the facility unassisted. Staff interviews revealed they were not aware R1 was left the facility unassisted as they were assisting other residents. R1 left the facility in the evening when office staff were not present to observe the elopement. The administrator’s interview revealed the doors lock from the outside at nighttime but not from the inside due to safety reasons and fire clearance. 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: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

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-20240411093448

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: 04/18/2024

NARRATIVE

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The facility provides 24-hour supervision. However, the caregivers are assisting residents at all times of the day, and they are unable to watch the front door after hours. Staff interviews confirmed they check on residents every two (2) hours or sooner. The administrator has relocated R1 to their secured memory unit. The administrator is going to purchase a security system to alert them when the doors are opened in the evening hours. The facility has an Absentee Notification Plan on file for R1.

Based on interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation was 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 03/22) were provided to Staff, Adilene Ramirez 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: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20240411093448

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: 04/18/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/16/2024 Section Cited HSC 1569.312(d)	1 2 3 4 5 6 7	Basic services requirements. Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator stated they will purchase door alarms for exits to alert staff when the doors are being opened after hours.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not ensure supervision was provided to 1 out of 92 residents [R1], which 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: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC9099 (FAS) - (06/04)

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