197609621-8-22-2025-31-AS-TAGD-DMNMWC-20251021095803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 08/22/2025
Date Signed: 08/22/2025 03:24:16 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
06/27/2025 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20250627120455

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: 116	DATE:	08/22/2025
		UNANNOUNCED	TIME BEGAN:	12:19 PM
MET WITH:	Monique Lopez - Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure resident was seen by physician

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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

LPA conducted a physical plant tour at 12:33 PM, requested copies of facility documents relevant to the investigation at 1:00 PM, reviewed records between 1:00 PM to 1:35 PM and interviewed staff between 1:35 PM to 2:45 PM. Regarding the allegation that Staff did not ensure resident was seen by physician, it was alleged that a doctor was trying to speak with Resident #1 (R1) but Resident #2 (R2) told the doctor to get out of their room. LPA's interview with the administrator today at 1:40 PM revealed that R1 & R2 are in a relationship and living in one room, the visiting Social Worker (SW) of R2 upset R2 and became agitated so when the physician came to their room for a monthly routine checkup of R1, R2 yelled at the doctor to get out of their room and prevented R1 to see the physician. (contiued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

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 31-AS-20250627120455

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: 08/22/2025

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

(continued from LIC 9099)

Further interview also revealed that the physician went on to see other residents and went back and eventually saw R1 for the monthly routine checkup. LPA's record review at 1:00 PM confirmed that R1 was seen by the physician on the same day of the incident.

Based on the information gathered during this and prior visit, the allegation is 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: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2