374602369-4-18-2024-08-AS-LTEZ-D4PQJV-20240426121323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 04/18/2024
Date Signed: 04/18/2024 09:35:05 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
04/15/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240415103954

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:	12:00 PM
MET WITH:	Staff, Adilene Ramirez		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not assist resident with feeding
Facility smells of mold

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the above-mentioned allegations. 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, residents, and outside sources. It was alleged staff did not assist resident with feeding. It was reported Resident #1 (R1) was being served food by staff, but they were not assisting R1 with feeding. Outside source interviews revealed there were times staff would feed R1, while R1 was lying in bed causing R1 to choke. Outside sources also reported staff would bring R1 food and would take the full plate of food away if R1 didn’t eat. However, R1 didn’t eat because they were unable to feed themselves. R1’s Physician’s Report dated 03/29/24 indicated R1 was able to feed themselves. R1’s Preplacement Appraisal dated 04/01/24 indicated R1 was able to feed themselves with a modified diet. R1’s interview confirmed they were able to feed themselves and prefers to feed themselves. R1 was able to demonstrate feeding themselves. Continued on an LIC 9099C.

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: 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-20240415103954

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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R1 reported staff assist with all meals but they do not want assistance. R1 received a new hospital bed and is able to sit up to eat. R1 requested an across the bed table tray to allow for self-feeding. While at the facility, staff provided R1 with the table tray. Staff interviews confirmed they assist R1 with all meals and make the time to ensure they feed R1.

It was also alleged the facility smells of mold. Outside source interviews revealed they smell mold when they are present in the facility. Outside source interviews also stated they feel sick when they are in the building with side effects. Today, LPA did not observe mold or smell mold. LPA made past multiple visits to the facility on 02/21/24, 3/19/24, and 04/02/24 and there was no evidence of mold. The administrator’s interview confirmed they had a professional mold abatement company inspect the facility for mold, and there was no evidence of mold. Staff interviews confirmed they have not observed or smelled mold in the facility. Resident interviews also confirmed they have not observed or smelled.

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 Staff, Adilene Ramirez 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: 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)

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