306005848-10-8-2025-22-AS-APAO-DMQ2V3-20251022174315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005848
Report Date: 10/08/2025
Date Signed: 10/08/2025 11:06:37 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/25/2025 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250925090103

FACILITY NAME:	GOLDEN AGE SENIOR HOMES		FACILITY NUMBER:	306005848
ADMINISTRATOR:	MICO, RICO G.		FACILITY TYPE:	740
ADDRESS:	24982 WILKES PLACE		TELEPHONE:	(562) 338-4099
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	6	CENSUS: 5	DATE:	10/08/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Rico Mico		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Licensee does not ensure that facility is clean.
Licensee did not provide resident with linens.
Resident left in soiled diapers for an extended period.
Licensee allows minors to provide care and supervision to the residents
Residents are not provided with activities.
Residents are left unattended.
Licensee does not provide adequate care to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation to the above identified complaint allegations. LPA arrived at the facility and was greeted at the door and granted entry. LPA spoke with Rico Mico, Administrator and explained the purpose of the visit.

Findings are based upon this investigation which included tour of the facility, facility file review, resident file review and interviews conducted.

It is alleged that licensee does not ensure that facility is clean. LPA conducted a facility visit on September 30, 2025, and observed facility to be clean and sanitized. Staff were observed to be cleaning kitchen and resident bedrooms. LPA toured resident’s bedroom and did not observe there to be any urine on the

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

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 22-AS-20250925090103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GOLDEN AGE SENIOR HOMES	FACILITY NUMBER: 306005848
	VISIT DATE: 10/08/2025

NARRATIVE

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floors. Interview with staff stated that facility is cleaned every day throughout the day, and the facility is moped in the evenings once residents go to sleep. The interview with 3 of 3 residents stated that their room gets cleaned all the time.

It is alleged that licensee did to provide a resident (R1) with linens, specifically to pillowcases. LPA conducted a facility visit on September 30, 2025, toured the physical plant of the facility and observed linens stored in cabinet located in hallways leading to resident bedrooms and in large closet storage to the right of facility restroom. LPA toured the resident bedrooms and observed all bedrooms to have pillows with pillowcases in each of the residents’ beds. Interview with staff stated that facility has plenty of linens and is sufficient amount for all residents use.

It is alleged that resident left in soiled diapers for an extended period. Interview with witness stated that they have never seen residents in soiled diapers or soiled at all. Interview with staff stated that residents with diapers are checked often for diapers if they are soiled. Diapers get changed often as needed. Interview with 3 of 3 residents stated that they get help from staff and check on often as needed.

It is alleged that licensee allows minors to provide care and supervision to the residents, specifically in reference to licensees two daughters. LPA Martinez obtained copies of licensee’s daughters in question and revealed that daughters are of the age of 20 and 24. Both daughters are fingerprint cleared and associated with the facility. Interview with licensee/administrator stated that they only have 2 daughters and neither are minors. No minors ever help at the facility with the care of the residents.

It is alleged that residents are not provided with activities. LPA conducted a tour of the facility on September 30, 2025, and observed the facility has board games, books, and other recreational materials for the residents’ use. Interview with staff stated that they have exercise sessions for residents, puzzles, crafts and take them out of the facility. Interview with 3 of 3 residents stated that the facility has exercise sessions,

Continued on LIC9099-C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250925090103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GOLDEN AGE SENIOR HOMES	FACILITY NUMBER: 306005848
	VISIT DATE: 10/08/2025

NARRATIVE

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puzzles, crafts and take them outside of the facility. Residents stated that when they don’t want to go out staff do not force them to do so.

It is alleged that residents are left unattended. Interview with staff stated that residents are always cared for and care is provided at all times. Residents are assisted when they ask for it and staff do resident checks all the time. There is always 3-4 staff on board at all times. File review LIC500 personnel report reflects that there are 4 staff listed. Interview with 3 of 3 residents stated that they are never alone and there is staff with them at all times. Interview with witness stated that they have always seen staff at the facility when they have conducted visits.

It is alleged that licensee does not provide adequate care for residents, specifically to oxygen treatments for resident (R1). Interview with 3 of 3 staff stated that when R1’s oxygen is low they do utilize the oxygen for them. Staff stated that they check R1’s oxygen all the time because they know R1 needs it. Records review revealed that R1 has hospice services and part of services provided if oxygen treatment. Interview with R1 stated that they get oxygen treatment as much as they need it at all times.

Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated.

An exit interview was conducted with the Administrator and a copy of this LIC9099 report was left at facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC9099 (FAS) - (06/04)

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