374602369-6-19-2024-08-AS-CLOZ-D6DMVU-20240619095719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602369
Report Date: 06/19/2024
Date Signed: 06/19/2024 09:58:04 AM

Document Has Been Signed on 06/19/2024 09:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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: 91	DATE:	06/19/2024
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Yahira Gardunio Ramirez, Office Manager/Supervisor		TIME COMPLETED:	09:45 AM

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	Licensing Program Analyst (LPA) Carmen Lopez arrived on June 19, 2024, for an unannounced case management visit to follow-up on a substantiated complaint investigation. LPA met with Yahira Gardunio Ramirez, Office Manager/Supervisor and reviewed the report. On May 20, 2022, the Department concluded a complaint investigation which alleged the following allegation: licensee did not ensure needed medical care for a resident. The allegation was substantiated, and the licensee was cited for a violation as a Type A deficiency under California Code of Regulations Title 22 (22 CCR), § 87465(g) Incidental Medical and Dental Care, which states in part, “The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health…”. The investigation revealed that on May 29, 2020, a resident (R1) fell at the facility and complained of lower back pain. Staff interview statements admitted they observed R1 as being in “extreme pain,” but the facility did not contact 911 to have R1 medically evaluated for injury. A physician’s report dated May 29, 2020, diagnosed R1 with major neurocognitive impairment, characterized by frequent confusion and a history of wandering behavior. Resident appraisal records dated May 30, 2020, noted R1 as a fall risk and documented that R1 needed close supervision and monitoring. Facility records documented that R1 had two subsequent falls on May 30, 2020, and June 3, 2020. R1 verbally communicated additional back and leg pain to multiple staff; however, the facility failed to provide or arrange any medical evaluation. R1 continued to complain of pain up until their last day at the facility, June 6, 2020. While being transported to a new facility on June 6, 2020, R1 expressed hip pain to outside sources. R1 was immediately taken to the hospital and subsequently diagnosed with a hip fracture. An interview with an outside medical professional confirmed the fracture was an “acute fracture”, meaning it had occurred within a six-week timeframe while R1 resided at the facility. Medical records dated June 6, 2020, confirmed R1 underwent hip surgery, was hospitalized for two weeks, and then discharged into another licensed care facility on June 21, 2020. (Continuation on LIC809-C)

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/19/2024

NARRATIVE

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At the time of the complaint visit on May 20, 2022, an immediate civil penalty of $500 was assessed and the licensee was informed that a civil penalty might be assessed based on Health and Safety section 1569.49.

The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section 15610.67 defines serious bodily injury as "an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility’s neglect and lack of emergent care, after a fall that resulted in an untreated fracture led to R1’s pain and suffering.

Today June 19, 2024, the Department is issuing a civil penalty per Health and Safety Code 1569.49(f) for a violation that the Department constitutes as serious bodily injury, in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on May 20, 2022, the amount of the civil penalty issued today will be $9,500.

A copy of the LIC 421D form was given to Yahira Gardunio Ramirez, Office Manager/Supervisor and originals were signed.

An exit interview was conducted, a copy of this report was issued, and appeal rights were provided. Yahira Gardunio Ramirez, Office Manager/Supervisor's signature on this report acknowledges receipt of the appeal rights, found on page two of the LIC 421D.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC809 (FAS) - (06/04)

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