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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201224
Report Date: 12/16/2025
Date Signed: 12/16/2025 02:00:41 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2025 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20251022165415
FACILITY NAME:GOLDEN LIVING GUEST HOMEFACILITY NUMBER:
019201224
ADMINISTRATOR:AYE, THINNFACILITY TYPE:
740
ADDRESS:9450 MOUNTAIN BLVDTELEPHONE:
(510) 509-4635
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:6CENSUS: 6DATE:
12/16/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Htake Win, Care StaffTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff physical abused resident
Staff verbally abused resident
INVESTIGATION FINDINGS:
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On 12/16/25 at 1:30 PM Licensing Program Analyst (LPA) Gregory Clark arrived unannounced to deliver findings in regard to the allegations above. LPA spoke with Thinn Aye, Administrator (ADMIN) and informed her of the reason for the visit. ADMIN gave permission for care staff Htake Win to sign the report.

During the course of investigation LPA interviewed R1, facility staff, Administrator at R1’s current placement, R1’s Center for Elders Independence Social Worker (SW) and R1’s Occupational Therapist. LPA also reviewed R1's file.

R1 was placed at the facility by her social worker on July 23, 2025, after being transferred from her assisted living apartment due to a decline in condition requiring 24-hour care. Review of R1’s file and interviews with staff indicated that R1 was unhappy with her placement and frequently refused care.

***report continues on LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
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 2
Control Number 15-AS-20251022165415
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: GOLDEN LIVING GUEST HOME
FACILITY NUMBER: 019201224
VISIT DATE: 12/16/2025
NARRATIVE
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***report continues from LIC9099***

Documentation and staff statements also noted that R1 was often combative and physically aggressive with staff. Staff reported multiple incidents in which R1 scratched, hit, or attempted to strike caregivers. The Administrator provided photographs of scratches on staff members’ arms reportedly caused by R1.

Interviews with all staff involved revealed that no staff member witnessed R1 being physically abused or yelled at by staff. Staff denied the allegations and stated that they continued to attempt care despite R1’s refusal and combative behavior. Records showed that R1 had called 911 on several occasions accusing staff of physical abuse and yelling; however, no evidence was found to substantiate these allegations.

LPA interviewed R1 at CEI in Concord. R1 was pleasant and talkative during the interview and shared various personal stories. When asked about her stay in Oakland, R1 shook her head, frowned, and stated, “I forget now.” R1 recalled one incident in which a staff member allegedly pushed a walker into her leg, causing a bruise, but she was unable to provide additional details regarding the date, staff involved, or surrounding circumstances.



This agency has investigated the above complaint. We have found that the complaint was unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2