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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 390312403
Report Date: 09/02/2026
Date Signed: 09/02/2026 11:22:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2026 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260526154628
FACILITY NAME:GOLDEN HAVENFACILITY NUMBER:
390312403
ADMINISTRATOR:ROWENA RAMIREZFACILITY TYPE:
740
ADDRESS:2324 LEVER BLVD.TELEPHONE:
(209) 464-4743
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:150CENSUS: 42DATE:
09/02/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:C. RodacherTIME COMPLETED:
03:04 PM
ALLEGATION(S):
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Staff are not allowing resident visitations.
Staff do not afford resident privacy.
INVESTIGATION FINDINGS:
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On 09/2/2026, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced at this facility to conduct a complaint visit. LPA met with Staff Members and explained the purpose of the visit.

Based on interviews, records reviewed, and regulatory requirements, the allegation that Golden Haven violated the personal rights of R1 is substantiated. Although the Public Guardian’s Office issued visitation restrictions without judicial approval, the facility implemented the restrictions believing they were authorized. No evidence supports that the facility knowingly or willfully violated personal rights.The investigation included interviews with facility staff, the administrator, the Public Guardian’s Office, and family members. Licensing also reviewed conservatorship documents, facility policies, resident records, and the July 09, 2026 visitation directive issued by the Public Guardian’s Office. The Public Guardian’s Office submitted a letter imposing visitation restrictions; however, no court order, judicial approval, or conservatorship condition authorizing limitations on personal rights was provided. The facility implemented the restrictions based solely on the Public Guardian’s directive.

Based on interviews and records reviewed, the allegation is substantiated. As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D page, per Title 22 Regulations.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2026 and conducted by Evaluator Albert Johnson
COMPLAINT CONTROL NUMBER: 27-AS-20260526154628

FACILITY NAME:GOLDEN HAVENFACILITY NUMBER:
390312403
ADMINISTRATOR:ROWENA RAMIREZFACILITY TYPE:
740
ADDRESS:2324 LEVER BLVD.TELEPHONE:
(209) 464-4743
CITY:STOCKTONSTATE:CAZIP CODE:
95206
CAPACITY:150CENSUS: DATE:
09/02/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:C. RodacherTIME COMPLETED:
03:04 PM
ALLEGATION(S):
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Staff is over medicating resident.
INVESTIGATION FINDINGS:
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Based on interviews, records reviewed, and observations, the allegation that staff over-medicated the resident is unfounded. The RP’s concerns were based on observations during visits; however, no evidence supports that staff administered medication improperly or in excess. All medication practices were found to be consistent with physician orders and regulatory requirements.

RP observed his father appearing unusually sedated; however, RP did not know the medications being administered and did not review medical records.
Facility records show no evidence of over-medication, unauthorized medication administration, or deviations from physician orders.
Staff interviews consistently reported that medications are administered as prescribed and that the resident has not exhibited signs of excessive sedation.
Conservatorship office confirmed no concerns regarding medication practices.
No evidence supports that the resident was over-medicated or that staff administered medication outside of physician direction.

Based on statements obtained, records review and observations during the investigation process, LPA was unable to corroborate the allegations. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260526154628
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GOLDEN HAVEN
FACILITY NUMBER: 390312403
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2026
Section Cited
CCR
87468.1(1)(10)
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87468.1 (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
(10) To be informed of the licensee’s policy concerning visits and other communications with residents, according to Health and Safety Code section 1569.313.
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The facility will obtain an court order signed by a judge to implement the restrictions outline in the complaint allegations. This will be provided to the department by the POC date 9/16/2026
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This requirement is not met as evidenced by a letter imposing visitation restrictions; however, no court order, judicial approval, or conservatorship condition authorizing limitations on personal rights was provided.
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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: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3