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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602369
Report Date: 04/02/2024
Date Signed: 04/02/2024 05:39:56 PM


Document Has Been Signed on 04/02/2024 05:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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
ADMINISTRATOR:ROCIO GRANDAFACILITY TYPE:
740
ADDRESS:3223 DUKE STREETTELEPHONE:
(619) 222-1109
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:113CENSUS: 91DATE:
04/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Business Office Manager, Monica CordovaTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPAs), Natasha Persaud and Ryan Fulton conducted a Case Management - Incident visit. LPAs met with Administrator, Rocio Granda and Business Office Manager, Monica Cordova and discussed the purpose of the visit.

During today's visit, LPAs briefly toured the facility, request records, and interviewed staff and residents. Community Care Licensing received a self reported incident involving Resident #1 (R1). The report stated on 03/26/24, R1 was transported to the hospital for chest pain. R1 refused to return to the facility once discharged and threatened harm to themselves and others. The administrator stated R1 was discharged back to the facility and was calm upon arrival. The administrator also implemented increased status checks, and had a meeting with R1, and staff to ensure R1's safety.

No deficiencies were issued today. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Business Office Manager, Monica Cordova whose signature below confirms receipt of these rights.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:
DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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