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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609631
Report Date: 12/09/2025
Date Signed: 12/09/2025 01:56:25 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
12/04/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20251204081145
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: 49DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Itzel Guevarra - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff speaks inappropriately to resident

Staff do not ensure resident has privacy in their bedroom
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 Itzel Guevarra and explained the reason for the visit.

LPA conducted a physical plant tour at 9:23 AM, requested copy of facility documents relevant to the investigation at 10:02 AM, reviewed records from 10:15 AM to 11:15 AM and interviewed staff and residents between 11:15 AM and 1:00 PM. Regarding the allegation that Staff speaks inappropriately to resident, it was alleged that staff told Resident #1 (R1) "a drunk and every bad thing a person can call a person". LPA’s record review today between 10:15 AM to 11:15 AM revealed that R1 made similar allegations on 05/16/24 under complaint control number 31-AS-20240516145438 and then again on 11/04/24 under complaint control number 31-AS-20241104113106 and again on 07/31/ 25 under complaint control number 31-AS-20250731111405. All were unsubstantiated (please see reports on the same date). (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
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-20251204081145
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: 12/09/2025
NARRATIVE
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(continued from LIC 9099)

LPA’s interview with R1 today at 11:19 AM revealed that R1 did not directly hear any staff talking to or about R1 but heard it over the speaker on the wall and the Television on R1's room. LPA did not observe any speaker on the wall nor a hidden camera nor a bug in R1's room. LPA's interview with the Assistant Administrator today at 1:12 PM revealed that this is an ongoing thing with R1 that whenever R1 goes to the hospital or anywhere else outside of the facility such as mental health clinics or the like.

Regarding the allegation that Staff do not ensure resident has privacy in their bedroom, it was alleged that staff put a “bug by the end table and can tell what R1 was reading and they have a microphone and cameras in R1's room. LPA's observation today revealed that there was no speaker on the wall, no microphone or any camera's installed in R1's room. LPA's interview with the Administrator today confirmed that the facility doesn’t install any microphone, "a bug" and/or camera in R1's room. LPA's record review today also revealed that R1 had a mental health condition that causes paranoia.

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: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2