<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607201
Report Date: 05/22/2025
Date Signed: 05/22/2025 08:51:56 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2025 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250311171006
FACILITY NAME:GOLDEN CITY HOME CAREFACILITY NUMBER:
197607201
ADMINISTRATOR:ANTONIA DIONISIOFACILITY TYPE:
740
ADDRESS:2451 W. 230TH STREETTELEPHONE:
(310) 325-1995
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 3DATE:
05/22/2025
UNANNOUNCEDTIME BEGAN:
08:23 AM
MET WITH:Will PisonTIME COMPLETED:
09:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Suspicious death.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/12/2025, Licensing Program Analysts (LPAs) Regina Cloyd and Jose Anguiano conducted a complaint investigation at the above facility to address the following allegations. LPAs met with Staff and Administrator Antonia Dionisio and explained the purpose of the visit. On 03/28/25, LPA Cloyd conducted a subsequent visit and met with Staff and Administrator Antonia Dionisio. On 05/22/25, LPA Cloyd conducted a subsequent visit to deliver findings for the seventh allegation.

The investigation consisted of the following:
On 03/12/2025, LPAs conducted resident, staff, and witness interviews, toured the facility, and reviewed resident records. On 03/28/25, LPA interviewed one witness and delivered findings for six out of seven allegations.

Continue to LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
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 11-AS-20250311171006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GOLDEN CITY HOME CARE
FACILITY NUMBER: 197607201
VISIT DATE: 05/22/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation "suspicious death,” it is being alleged that Resident #1 (R1) did not show any signs of illness other than being uncomfortable. It is alleged that R1 did not give the facility permission to be placed on hospice. Record review of R1’s physician’s report (02/22/25) revealed that R1 had cancer and poor health. Record review of hospice report revealed R1 was diagnosed with secondary malignant neoplasm of bone and R1 passed away peacefully. Death report revealed R1 was admitted to hospice at the same time R1 moved into the facility on 02/23/25 and died on 03/11/2025 11:59 AM. S1 indicated that R1 was discharged from the hospital and arrived to the facility very weak. On the day of arrival, he was placed on hospice. W1, R1’s son, indicated that R1 was already tired due to stage 4 terminal cancer. W1 indicated that R1 did not want to end up on hospice but R1 needed to be supervised due to declining health. Interview with Witness #3, from the hospice company, indicated that R1’s death was natural.

Regarding the allegation “suspicious death," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

An exit interview was conducted with Administrator Antonia Dionisio over the phone and a copy of this report was provided to the Staff Will Pison.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2