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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609828
Report Date: 08/29/2024
Date Signed: 08/29/2024 09:57:09 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
03/08/2024 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20240308160649
FACILITY NAME:NO PLACE LIKE HOME FOR GOLDEN AGES 3, LLCFACILITY NUMBER:
197609828
ADMINISTRATOR:MELIK, DIANEFACILITY TYPE:
740
ADDRESS:3754 MONTROSE AVE.TELEPHONE:
(747) 255-7188
CITY:GLENDALESTATE: CAZIP CODE:
91214
CAPACITY:6CENSUS: 5DATE:
08/29/2024
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Estelita San Pedro, CaregiverTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Resident was encourge to appoint licensee as their POA.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit to deliver the findings for the above noted allegation. LPA met with caregiver Estelita San Pedro and explained the reason for the visit.

It was reported that a resident was encouraged to appoint the Licensee as their power of attorney (POA). It was alleged that the Licensee was pressuring Resident #1 (R1) to make them their POA in exchange for two months of free rent at the facility. To investigate this allegation, on 03/12/2024, LPA attempted to interview R1. LPA was not able to speak to R1 since they were out of the community. Between 4:00pm and 5:00pm, staff interviews were initiated. Staff denied that they were encouraging R1 to make them their POA. On 8/29/2024, LPA Valenzuela conducted a subsequent visit to the facility to continue the investigation. LPA requested to speak to R1, but was told by staff that they no longer live there. R1 left the community sometime in the month of March. LPA was not able to contact R1, since the phone number provided was no longer in service.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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-20240308160649
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: NO PLACE LIKE HOME FOR GOLDEN AGES 3, LLC
FACILITY NUMBER: 197609828
VISIT DATE: 08/29/2024
NARRATIVE
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Based on interviews, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

No health and safety issues noted at the time of this visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2