345920176-1-22-2026-59-AS-TORZ-DR33UX-20260206173416

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345920176
Report Date: 01/22/2026
Date Signed: 01/22/2026 02:58:41 PM

Unsubstantiated

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
01/12/2026 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 59-AS-20260112110037

FACILITY NAME:	GOLDEN AGE LIVING 1		FACILITY NUMBER:	345920176
ADMINISTRATOR:	SOUMAHORO, MUAMOUDOU A		FACILITY TYPE:	740
ADDRESS:	3375 LA CADENA WAY		TELEPHONE:	(916) 389-9683
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	6	CENSUS: 2	DATE:	01/22/2026
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Helen Scarlett and Judith Gayle		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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1. Staff intimidated a resident in care.
2. Staff yelled at a resident in care.
3. Staff did not provide a variety of meals to a resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kerry Hiratsuka conducted this unannounced complaint visit to deliver the results of the allegation above.

LPA reviewed facility records and conducted interviews.

1. Resident stated a staff person waived a knife in their face. A third party heard the resident say a staff person was waiving a knife in their face. The staff person (S1) stated S1 was cutting meat at the counter and the resident was sitting on in the dining area, on the other side of the table away from the S1. S1 stated they put the knife down on the counter when they turned around to talk to the resident. There were no other residents or staff in the area to confirm or deny the incident. Because each side has their version of events and there are no direct witnesses LPA cannot prove or disprove the allegation.

Caregiver stated she was uncomfortable to sign report and declined to sign.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

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 59-AS-20260112110037

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: 01/22/2026

NARRATIVE

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2. Staff stated they didn't verbally abuse the residents. There were no direct witnesses to confirm or deny the incident occurred. A witness stated they heard S1 yelling at the resident. Recordings were submitted to LPA. LPA cannot determine if the staff person was yelling at the resident or attempting to explain what was occurring to the witness and had to talk loudly to be heard. Staff stated they don't yell at the resident and were the ones getting yelled at. Other residents interviewed stated the staff do not yell at them and they haven't heard any of the staff yelling at anyone else. Because each side has their version of events LPA cannot prove or disprove the allegation.

3. Resident told a staff person they didn't want what was being prepared for lunch and wanted something else. Resident stated they didn't what they asked for. Staff person stated the resident initially wanted one thing that had to be cooked in the oven and then stated later the resident wanted something else at the same time. Staff person stated the resident had to chose one or the other because one of the items was going to take awhile to cook. Staff stated they would make the second choice for lunch and then the other for dinner since it was going to take awhile to make. Resident stated they didn't get anything. Staff stated the resident was given the second request for lunch. There were no direct witnesses in the room to confirm or deny the incident occurred.

Because there is not enough evidence the incidents occur or did not occur, the allegation cannot be proved or disproved.

Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Caregiver stated she was uncomfortable to sign report and declined to sign.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

LIC9099 (FAS) - (06/04)

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