197606171-10-27-2025-28-AS-WSHO-DQS2P9-20260128163357

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606171
Report Date: 10/27/2025
Date Signed: 10/27/2025 04:52:07 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

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 Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251022084029

FACILITY NAME:	GOLDEN MANOR RETIREMENT CENTER		FACILITY NUMBER:	197606171
ADMINISTRATOR:	MARIA JACOBO		FACILITY TYPE:	740
ADDRESS:	1109 WEST BEVERLY BLVD.		TELEPHONE:	(323) 724-3870
CITY:	MONTEBELLO	STATE: CA	ZIP CODE:	90640
CAPACITY:	160	CENSUS: 80	DATE:	10/27/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Staff Carmen Virrueta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff abandoned resident
Illegal eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Staff Carmen Virrueta and explained the reason for the visit.
The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegations.
At today's visit the following was done:
On 10/27/2025 Staff Carmen Virrueta was interviewed.
Staff S1 and Staff S2 were interviewed.
Resident and Staff Roster submitted.
Resident's R2-R8 were interviewed. Interview conducted with family member of Resident R1.
File was reviewed for Rsident R 1 and VA Medication , Physician's Report , Special Incident Report (SIR) and ID page were submitted.
In regards to the allegation Staff abandoned resident, based on interviews conducted and information gathered it was revealed by the family member of Resident R1 who stated that the facility did nothing wrong and that they are nice people.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20251022084029

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GOLDEN MANOR RETIREMENT CENTER	FACILITY NUMBER: 197606171
	VISIT DATE: 10/27/2025

NARRATIVE

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Stated R1 makes false accusations and was physically aggressive at the facility.
Said R1 walked to the donut shop up the street and they called 911. He ended up at Whittier Hospital and family member said it was him who took R1 to the VA and it's not true that R1 was abandoned.
Case Manager at the VA for R1 stated that it definitely wasn't abandonment in regards to R1.
R1 was very aggressive and a danger to staff and residents. Said R1 wanted to go to the hospital saying was sick. Has had multiple ER visits.
Spoke with staff who stated that the family member of R1 had taken him to the VA and thus it is not true about being abandoned. Family member told them it's too much with his behaviors so he would take to the VA Hospital.
Resident's R2-R8 all stated that staff are really good. Said they are treated well. Said staff aren't inappropriate that it is resident's inappropriate toward staff.
Resident R6 and R8 stated that R1 was screaming that he hates it here, throwing tables, chairs, library books and scaring alot of resident's. Stated that staff did a good job of calming down R1.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to the allegation Illegal eviction based on interviews conducted and information gathered it was revealed by the family member of Resident R1 who stated that the facility did nothing wrong and that they are nice people.
Stated that R1 makes false accusation's saying they stole his wallet, but the hospital called saying they had it. Told him they stole his boots and then they were found.
Said R1 has memory problems and also was physically aggressive to staff and resident's.
Said it is not true that it was an eviction.
Case Manager at the VA for R1 stated that it definitely wasn't an eviction in regards to R1. Stated it was R1 who didn't want to return and was a danger to himself and others at the facility.
R1 was very aggressive and a danger to staff and residents. Said R1 wanted to go to the hospital saying was sick. Has had multiple ER visits.
Spoke with staff who stated that the family member of R1 had taken him to the VA . Family member told them it's too much with his behaviors so he would take to the VA Hospital. Stated R1 wanted to go back to the Ridgecrest area and kept screaming I hate it here.
Resident's R2-R8 all stated that staff are really good. Said they are treated well. Said staff aren't inappropriate that it is resident's inappropriate toward staff.
Resident R6 and R8 stated that R1 was screaming that he hates it here, throwing tables, chairs, library books and scaring alot of resident's. Stated that staff did a good job of calming down R1 and never did staff threaten R1 with eviction.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025

LIC9099 (FAS) - (06/04)

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