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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920176
Report Date: 12/04/2025
Date Signed: 12/04/2025 04:18:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2025 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20251125162613
FACILITY NAME:GOLDEN AGE LIVING 1FACILITY NUMBER:
345920176
ADMINISTRATOR:SOUMAHORO, MUAMOUDOU AFACILITY TYPE:
740
ADDRESS:3375 LA CADENA WAYTELEPHONE:
(916) 389-9683
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:6CENSUS: 6DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Sylvia Anaeke and Helen ScarlettTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not ensure resident's incontinence care is being met.
Staff did not respond to resident's call button in a timely manner.
INVESTIGATION FINDINGS:
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On December 4, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the allegation of the complaint above. LPA met with staff and explained the purpose of the visit.

For the allegations, Staff did not ensure resident's incontinence care is being met, and Staff did not respond to resident's call button in a timely manner, LPA conducted extensive interviews. Interviews conducted revealed that staff serve dinner at approximately 4:00 PM and "wraps up" residents at approximately 8:00 PM. Interview conducted with Licensee, confirmed dinner is typically served at 4-4:30 PM. Interview conducted with staff (S1) revealed that five out of six residents required incontinence care. Last depend change is completed at 8:00 PM. Interview conducted with resident (R1) revealed that staff are "good at changing" in the day but if an incontinence accident occurs in the middle of the night, staff does not respond for changing. R1 stated this typically occurs around midnight and staff will assist with changing around 7:00 AM.

Please continue on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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 59-AS-20251125162613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GOLDEN AGE LIVING 1
FACILITY NUMBER: 345920176
VISIT DATE: 12/04/2025
NARRATIVE
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LIC 9099-C

Interview conducted with resident (R3) revealed that incontinence care at night does not exist. R3 stated R3 requires full assistance with incontinence care by staff, last depend change occurs after dinner around 5:00-6:00 PM. R3 reported no assistance is available around 8:30 PM. Interview conducted with resident (R4) revealed that there have been multiple occasions where R4 soiled themselves in the middle of the night. R4 stated R4 tries to use call lights at night for emergencies only since staff are sleeping, but majority of the time, staff does not wake up to the call light as it is located in the kitchen away from the staff room which is separated by a fire door. Interview with R4 further revealed that there was a night where call light was triggered approximately at 10:00 PM but staff did not wake up to the call so R4 was left sleeping in wet depends which leaked to the bedding until morning.

Based on the information obtained, the allegations are SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following allegation cited above is substantiated; however, no deficiencies issued as facility was cited for similar allegations substantiated on December 4, 2025 for Complaint 59-AS-20251028090844.

Exit interview conducted and a copy of the report and appeal rights was provided

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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