197609621-12-17-2025-31-AS-TAGD-DS9T3Q-20260317142240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 12/17/2025
Date Signed: 12/17/2025 01:55:47 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
12/09/2025 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20251209142255

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: 108	DATE:	12/17/2025
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Monique Lopez - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not intervene when residents engage in verbal altercations

Staff did not ensure that residents are provided a safe environment

Staff did follow reporting requirements

INVESTIGATION FINDINGS:

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

LPA conducted a physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 10:32 AM and interviewed staff and residents between 10:45 AM and 1:00 PM. Regarding the allegation that Staff do not intervene when residents engage in verbal altercations, it was alleged that the reporting party (RP) heard a verbal altercation coming from a room. RP overheard a male voice yelling and possibly throwing items in the room with the door closed. RP also heard a female voice yelling. LPA's interview with Resident #1 (R1) today at 11:40 AM, the resident who was heard yelling revealed that there was no altercation happened and R1 was just talking on the phone and having an argument with someone on the phone. Further interview also revealed that R1 was alone in the room when the incident occurred.
(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025

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-20251209142255

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: 12/17/2025

NARRATIVE

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(continued from LIC 9099)

LPA's interview with Staff #1 (S1) today at 12:03 PM, who was requested by RP to go to R1's room when the incident occurred, confirmed that R1 was alone in the room and R1 was talking on the phone when S1 arrived at R1's room.

Regarding the allegation that Staff did not ensure that residents are provided a safe environment, it was alleged that per Resident #3 (R3), residents in that room (R1's room) argue all the time and it is unclear if the altercations get physical and R1 yelled at R3 and informed the staff of the verbal abuse against R3 by R1. LPA's interview with R1 today at 11:40 AM revealed that there was no physical or verbal altercation happened in R1's room as R1 was alone in the room, R1 had no one to argue or to physically fight with. R1 admitted to having yelled at R3 only because R3 had been in "everyone's business" and kept on bugging R1 and not leaving R1 alone.

Regarding the allegation that Staff did follow reporting requirements, it was alleged that as a mandated reporter the altercation should have been reported to the required agencies. LPA's record review today at 12:30 PM and interview with staff and residents, there was no verbal abuse or any altercation occurred and therefore there was nothing serious that needs to be reported to any agency.

Based on the information gathered during this 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: 12/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025

LIC9099 (FAS) - (06/04)

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