374602369-1-8-2025-08-AS-RCLK-DDJMHF-20250203083729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 01/08/2025
Date Signed: 01/08/2025 05:01:41 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
11/26/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20241126122416

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: 87	DATE:	01/08/2025
		UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Office Assistant, Yahaira Garduno		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not repair wall allowing rodents into the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted a visit to conclude the complaint investigation regarding the above mentioned allegation. LPA met with Administrator, Rocio Granda and Office Assistant, Yahaira Garduno.

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 repair a wall in a resident’s room allowing rodents into the facility. It was reported rodents were entering a resident’s room through a hole in the wall located under the bathroom sink. Staff interviews revealed the hole was patched by maintenance. However, LPA observed the hole on 12/05/24 and it was not completely repaired, allowing rodents access. Resident interview confirmed observing a rodent in their room. The facility was made aware of the rodent issue and did not resolve the issue. The wall was not patched completely, and a pest control company was not contacted for inspection once the facility had knowledge. After LPA’s visit on 12/05/24, the facility contacted a pest control company, and the facility was inspected on 12/06/24 and treated as a precautionary measure, as no live rodents were discovered. Continued on an LIC 9099C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

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 6

Control Number 08-AS-20241126122416

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 01/08/2025

NARRATIVE

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A review of the pest control invoices indicated on 08/09/24, the facility’s rooms were last inspected for pests/rodents by the same pest control company, no pests/rodents were observed. On 08/09/24, the pest control company recommended the walls be patched. There was a prior inspection conducted on the same room having the hole in the wall on 05/25/23, the facility was instructed to repair wall damage and penetrations to exclude pests. As of today, 01/08/25 there have been no reports of pests/rodents and the hole in the wall was repaired. The administrator explained they have a contract with the pest control company and will contact them if there are any further reports. The facility was aware of the rodent issue and attempted to patch the hole in the wall but was unsuccessful. Also, the facility did not contact the pest control once receiving the notification of rodents in resident’s room.

Based on observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Office Assistant, Yahaira Garduno whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 08-AS-20241126122416

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/08/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/15/2025 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator had the hole in the wall repaired and pest control inspect the resident rooms, which were treated as precautionary measurement. POC corrected.
	8 9 10 11 12 13 14	Based on observations and interviews the licensee did not ensure the facility was in good repair for 1 out 87 [R1] residents, which posed a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
11/26/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20241126122416

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: 87	DATE:	01/08/2025
		UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Office Assistant, Yahaira Garduno		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not ensure chemicals were inaccessible to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted a visit to conclude the complaint investigation regarding the above mentioned allegation. LPA met with Office Assistant, Yahaira Garduno.

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 ensure chemicals were inaccessible to residents. It was reported Resident #1 (R1) had access to Lysol and ingested a small amount on 11/24/24. Evidence obtained through interviews revealed there was a rodent in R1’s room and R1 was worried they encountered the rodent. Therefore, R1 diluted a couple of drops of Lysol with water and ingested it. Staff interviews revealed the paramedics were called and assessed R1. The paramedics did not believe it was necessary to transport R1 to the hospital due to a small amount of consumption and no symptoms. R1 confirmed the paramedics assessed R1 but didn’t deem R1 requiring additional medical treatment. R1’s Physician’s Report dated 06/15/22 indicated R1 was able to leave the facility unassisted; manage cash resources; able to store and administer their own medications; and not at risk if allowed direct access to personal grooming and hygiene items. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

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

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 08-AS-20241126122416

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 01/08/2025

NARRATIVE

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R1’s Resident Appraisal dated 04/07/23 indicated R1 required assistance with bathing, dressing/grooming, toileting. The appraisal also indicated the facility will provide medication administration. The facility also has documentation on file dated 8/29/24 indicating R1 was allowed to manage and store their own multivitamins but the facility will manage all other medications.

The administrator’s interview revealed R1 was independent and there were no concerns for R1 having access to cleaning supplies or medication. Administrator added R1’s physician deemed R1 safe by allowing R1 to manage and store their own multivitamins. The facility provided R1 with a locked drawer to store medications. Administrator also stated they were not aware R1 was had cleaning supplies in their room. Staff interviews revealed there were no concerns for R1’s safety and they had no knowledge R1 had access to cleaning supplies. Staff explained they observe items in resident’s room but do not look through their belongings. R1’s interview revealed they purchased Lysol and was storing it in their room in closed box that was identified in writing as “activities.” There was no way to determine what was in the box without searching through R1’s belongings. Staff confirmed they did not observe the closed box, as they are not allowed to look through the resident’s belongings. Resident #2 (R2) was R1’s roommate at the time of the incident. R2 confirmed they had no knowledge R1 was storing cleaning supplies and never observed it in their room. The facility staff confirmed they did not have knowledge R1 was purchasing items and storing them in their room the facility. On 12/19/24, the facility provided documentation to R1 explaining only residents with orders from their physician can store and manage medications and cleaning supplies. However, those items must be locked to protect other residents, R1 signed the document in agreement. Also, the facility has confiscated all R1’s cleaning supplies and has them locked. R1 was reassessed by their physician and the facility but there was documentation regarding R1’s safety around cleaning supplies. Due to the incident, the administrator believed R1 should no longer have access to cleaning supplies. The physician’s report and/or resident’s appraisal for Residential Care Facility for the Elderly does not have a question indicating if a resident can have access to cleaning supplies. Administrator explained if the resident is deemed safe to leave the facility unassisted and manage their own medications, that was an indication to the administrator that R1 was safe around cleaning supplies.

During 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 allegation. The allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Office Assistant, Yahaira Garduno whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1 and #2]

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC9099 (FAS) - (06/04)

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