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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606306
Report Date: 10/03/2025
Date Signed: 10/03/2025 06:01:54 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
09/26/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250926145715
FACILITY NAME:GOLDEN LEAF MANORFACILITY NUMBER:
197606306
ADMINISTRATOR:PERCY P. OLIDANFACILITY TYPE:
740
ADDRESS:1140 INDIAN SUMMER AVENUETELEPHONE:
(626) 855-0101
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:6CENSUS: 2DATE:
10/03/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Percy Olidan, AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Licensee does not have sufficient funds to maintain facility operating costs.
Licensee did not report the sale of property.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Cynthia Chan and Elena Mallett conducted a complaint investigation regarding the allegations above. LPAs arrived unannounced and met with the licensee/administrator, Percy Olidan. The purpose of the visit was explained.

LPAs obtained copies of the utility bill, bank statements, and interviewed the licensee.

Allegation - Licensee does not have sufficient funds to maintain facility operating costs. Per the licensee, she has sufficient funds to pay for all the bills. She stated she has been paying all her utility bills timely and any plumbing bills in the past. LPA obtained copies of the licensee’s bank statements and a current utility bill. The food supplies are sufficient for the 2 residents residing at the home. Based on records reviewed, the licensee has sufficient funds to pay the operating costs of the facility. The utility bills, such as electricity, gas, and water, have been paid.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025
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 28-AS-20250926145715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GOLDEN LEAF MANOR
FACILITY NUMBER: 197606306
VISIT DATE: 10/03/2025
NARRATIVE
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Allegation - Licensee did not report the sale of property. Per the licensee, the house was put up for sale about a year ago. At this time, the property has not been sold nor in escrow. The licensee stated she has informed the residents that she will be selling the property. She has also verbally reported to licensing of the intent to sell the property. Licensee is aware that she needs to inform licensing when she obtains a buyer. LPA reviewed some house listing websites, and the house is on the market but has not been sold.

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.



An exit interview was conducted with the licensee. A copy of this report, along with the appeal rights, was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2