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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602369
Report Date: 12/18/2024
Date Signed: 12/18/2024 08:26:27 PM

Document Has Been Signed on 12/18/2024 08:26 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GOLDEN LIVING HEALTH MANAGEMENT, INC.FACILITY NUMBER:
374602369
ADMINISTRATOR/
DIRECTOR:
ROCIO GRANDAFACILITY TYPE:
740
ADDRESS:3223 DUKE STREETTELEPHONE:
(619) 222-1109
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY: 113TOTAL ENROLLED CHILDREN: 0CENSUS: 85DATE:
12/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Administrator, Rocio GrandaTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Incident visit. LPA met Wellness Director, Diana Rodriguez and Administrator, Rocio Granda.

The facility self reported an incident that occurred on 12/10/24 involving Resident #1(R). The report indicated R1 was at dialysis center receiving treatment and began to have medical symptoms, including cardiac arrest. The dialysis center began CPR and contacted 911. R1 was transported to the hospital for evaluation and admitted to the intensive care unit. R1's Physician's Report dated 09/28/23 indicated R1 had acute respiratory failure and diabetes and required assistance with bathing, dressing/grooming, toileting and medication management. The administrator stated R1 was not admitted to the facility receiving dialysis treatment. Wellness Director explained R1 began dialysis on 11/20/24. R1 goes to dialysis center three times a week and is transported by a transportation company. On 12/10/24, the Wellness Director observed R1 as they were leaving for their dialysis appointment. R1 did not exhibit any symptoms or signs for concern. The Wellness Director also reported they touched R1's hand prior to entering the transportation vehicle, as they were assisting R1 and R1's skin was a normal temperature and not hot to the touch. There was no indication of a possible fever or other symptoms. The Wellness Director spoke with R1' social worker and discovered R1 passed away at the hospital on 12/17/24.

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 Administrator, Rocio Granda whose signature below confirms receipt of these rights.

Robyn ClarkTELEPHONE: (619) 767-2312
Natasha PersaudTELEPHONE: (619) 301-3594
DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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