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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609631
Report Date: 09/27/2025
Date Signed: 09/27/2025 01:50:09 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
06/11/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250611093220
FACILITY NAME:GOLDEN HILLS RETIREMENT CTR INCFACILITY NUMBER:
197609631
ADMINISTRATOR:GUEVARA, ITZELFACILITY TYPE:
740
ADDRESS:10159 HILLHAVEN AVETELEPHONE:
(818) 352-1559
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:60CENSUS: 44DATE:
09/27/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Adriana Cisneros - Assistant AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff left resident soaked in urine

Staff does not ensure resident has wheelchair access to the bathroom
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint to further investigate the above allegations. LPA initially met with staff Emily Shah who called the Administrator and explained the reason for the visit. Assistant Administrator arrived 30 minutes later.

LPA conducted physical plant tour at 8:30 AM, requested copy of facility documents relevant to the investigation at 9:02 AM and interviewed staff and residents between 9:30 AM to 12:00 PM. Regarding the allegation that Staff left resident soaked in urine, it was alleged that R1 was soaked in urine during Reporting Party’s (RP)’s visit. LPA's interview with R1 today at 10:02 AM, revealed that there was no time that R1 was left soaked or soiled for a long time and staff are regularly changing R1 at all times. LPA's interview with four (4) incontinent residents today revealed that four (4) out of four (4) residents interviewed stated that staff change them regularly and check on them regularly all the time.

(continuef on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2025
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-20250611093220
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 HILLS RETIREMENT CTR INC
FACILITY NUMBER: 197609631
VISIT DATE: 09/27/2025
NARRATIVE
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(continued from LIC 9099)

LPA's interview with two (2) staff today confirmed that they changed incontinent residents regularly four (4) to five (5) times a day during their shift and check on them every one and a half (1 1/2) hours to two (2) hours.

Regarding the allegation that Staff does not ensure resident has wheelchair access to the bathroom, it was alleged that R1 is unable to get into the available bathrooms. LPA's observation during physical plant tour revealed that the bathroom nearest R1's room is wheelchair accessible and about fifteen (15) feet away. Further, LPA observed that R1 was able to wheel self around the facility going to the dining room, TV room and office which is farther than R1's room. LPA's interview with the staff revealed that R1 would rather have the staff change R1's diapers rather than going to the bathroom.

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: 09/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2