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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157201730
Report Date: 09/13/2023
Date Signed: 09/18/2023 09:55:25 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/12/2023 and conducted by Evaluator Darius Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230612164835
FACILITY NAME:GOLDEN VILLA HOMEFACILITY NUMBER:
157201730
ADMINISTRATOR:SILVA, WENDYFACILITY TYPE:
740
ADDRESS:4420 FOXBORO CT.TELEPHONE:
(661) 564-8574
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:4CENSUS: 4DATE:
09/13/2023
UNANNOUNCEDTIME BEGAN:
03:49 PM
MET WITH:Administrator, Joan AquinoTIME COMPLETED:
04:46 PM
ALLEGATION(S):
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9
Staff mistreat client while in care
INVESTIGATION FINDINGS:
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5
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13
Licensing Program Analyst (LPA) Darius Williams conducted a follow up complaint visit to deliver findings. LPA Williams met with Administrator, Joan Aquino and discussed the purpose of the visit.

LPA Williams has conducted interviews and record reviews.

LPA Williams checked Guardian facility roster and did not see any names matching the alleged suspect name. According to the Administrator, no one has worked at the facility that goes by the alleged suspects name.

LPA Williams attempted to interviewed Resident 1 (R1) at their day program. R1 could not recall an incident of staff mistreating him or another person in care. R1 reported the facility has tough rules and when LPA Williams asked what the rules where, R1 replied, "They say we can't fight each other."

*Continued on LIC 9099C*
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
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 24-AS-20230612164835
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: GOLDEN VILLA HOME
FACILITY NUMBER: 157201730
VISIT DATE: 09/13/2023
NARRATIVE
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LPA Williams attempted to interview Resident 2 and Resident 3, with no success, and Resident 4 declined to talk.

According to Witness 1 (W1), R1 occasionally will discuss watched t.v. shows or movies as their own life. W1 reported they will have to ask R1, "Is this something you saw on t.v.,movie, or your life?" W1 reported R1 did not clarify which one it was.

Although the allegation may have happened or is valid, based on the alleged suspects name not matching an employee that works at the facility and LPA Williams unable to obtain clarifying information, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2