374602369-11-15-2022-08-AS-LTEZ-CLLTNM-20221128135257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 11/15/2022
Date Signed: 11/15/2022 04:02:26 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
11/09/2022 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20221109160427

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: 82	DATE:	11/15/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator, Rocio Granda		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was not able to attend dental appointment due to staff negligence

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegation mentioned above with Administrator, Rocio Granda

During the investigation, the facility was briefly toured, records requested, and interviewed staff and outside sources. It was alleged Resident #1 (R1) was not able to attend a dental appointment due to staff negligence. It was reported R1 had a dental appointment scheduled on 11/10/22 and the facility was made aware R1's medications needed to held/stopped five (5) days prior to the appointment. Outside source interviews revealed the facility was contacted on 11/03/22 reminding them to hold off on the medications starting tomorrow, 11/04/22, confirmation from the Medication Technician Supervisor was received that the medication will be stopped/held. Outside source interviews revealed contacting the facility's Medication Technician Supervisor on 11/09/22 to ensure all is well with R1 to attend dental appointment on 11/10/22. Written communication between the Medication Technician Supervisor and outside source was reviewed and revealed the facility did not stop/hold the medication over the weekend. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 08-AS-20221109160427

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: 11/15/2022

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
26
27
28
29
30
31
32

Medication Technician Supervisor's interview revealed being made aware the medications were supposed to be held/stopped and she provided confirmation it would be held/stopped. However, the facility did not have a current written order from R1's physician to hold/stop the medications. The Medication Technician Supervisor admitted she forgot to request the written order. However staff that dispense medications followed proper procedures because they continued to administer medications per the physician's orders, which was to take medications as prescribed. The facility did not have a current physician's order on file to hold/stop the medications for R1.

Based on interviews and record review, the Department was unable to obtain a preponderance of the evidence to prove the alleged allegation occurred. The allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee's Appeal Rights (LIC 9058 01/16) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2