197609621-6-19-2025-31-AS-TAGD-DJVUUJ-20250724155337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 06/19/2025
Date Signed: 06/19/2025 02:26:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/01/2025 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20250401102141

FACILITY NAME:	GOLDEN ASSISTED LIVING		FACILITY NUMBER:	197609621
ADMINISTRATOR:	LOPEZ, MONIQUE		FACILITY TYPE:	740
ADDRESS:	14060 ASTORIA ST		TELEPHONE:	(818) 367-1947
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	128	CENSUS: 117	DATE:	06/19/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Monique Lopez - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff are not providing the meals listed on the menu to residents

Staff are not providing adequate food service to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator Monique Lopez and explained the reason for the visit.

LPA conducted physical plant tour at 9:48 AM, requested copies of facility documents relevant to the investigation at 10:32 AM and interviewed staff and residents between 10:45 AM to 1:00 PM. Regarding the allegation that Staff are not providing the meals listed on the menu to residents, it was alleged that the new menu has 80% of the old menu items. LPA's record review and observation revealed that the facility hired a new chef on 04/17/25 and has since developed a new menu with a nutritionist. LPA's interview with the new chef revealed that since the chef took over, they always make sure that they serve whatever is on the menu and they plan ahead to ensure that they have all the meat, vegetables and all the ingredients in stock so they don't have to substitute. LPA's observation during today's visit and prior visit revealed that the meal they are serving on the day of the visit is what exactly was written on the menu. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025

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 31-AS-20250401102141

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GOLDEN ASSISTED LIVING	FACILITY NUMBER: 197609621
	VISIT DATE: 06/19/2025

NARRATIVE

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(continued from LIC 9099)

LPA's interview with four (4) residents on 04/02/25 between 10:21 AM to 1:00 PM and eight (8) residents today between 10:45 AM to 1:00 PM, revealed that twelve (12) out of twelve (12) residents stated that the food is okay to good and they serve on what is in the published menu.

Regarding the allegation that Staff are not providing adequate food service to residents, it was alleged that residents were served rotten roasted turkey that made some residents sick and that the fridge and freezers don’t work well because the meat has been defrosted and refrozen again with ice on them. LPA observed during physical plant tour today and prior visit on 04/02/25 that all the refrigerators and walk in freezers are working properly and all the foods were wrapped and labeled accordingly. LPA's interview with four (4) residents on 04/02/25 between 10:21 AM to 1:00 PM and eight (8) residents today between 10:45 AM to 1:00 PM, revealed that twelve (12) out of twelve (12) residents stated that they did not see nor remember eating a roasted turkey. LPA's interview with the reporting party (RP) today revealed that the RP was unable to name the resident who got sick while eating the rotten roasted turkey nor able to tell the date and time the alleged rotten turkey was served.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025

LIC9099 (FAS) - (06/04)

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