361881309-11-9-2022-56-AS-EMAN-CLNQ2C-20221130104656

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881309
Report Date: 11/09/2022
Date Signed: 11/09/2022 11:54:50 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221104153654

FACILITY NAME:	GOLDEN HORIZON SENIOR CARE		FACILITY NUMBER:	361881309
ADMINISTRATOR:	HAMED, EBRAHEEM		FACILITY TYPE:	740
ADDRESS:	1524 S EUCLID AVE		TELEPHONE:	(786) 564-3771
CITY:	ONTARIO	STATE: CA	ZIP CODE:	91762
CAPACITY:	22	CENSUS: 20	DATE:	11/09/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Ebraheem Hamed- Administrator		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Staff is threatening resident to take medication.
Staff is refusing to feed resident if they do not take medication.
Staff interfere with resident visiting.
Staff do not maintain the facility at a comfortable temperature for residents.
Staff is selling resident marijuana.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner arrived at the facility unannounced to initiate and deliver findings for the above complaint allegations. LPA met with Administrator Ebraheem Hamed and explained the reason for the visit. At the time of the visit there were three (3) staff and twenty (20) residents present.

During today’s visit, LPA was provided a current resident roster, resident meal logs for October 2022 and November 2022, and resident medication administration record (MAR) for the month of October 2022 and November 2022. LPA toured the facility, conducted interviews with residents, and conducted interviews with staff.

For allegation, Staff is threatening resident to take medication:

LPA interviewed staff and residents, during interviews conducted LPA was informed that residents have the right to not take their medication if they chose not to take it.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

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 56-AS-20221104153654

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GOLDEN HORIZON SENIOR CARE	FACILITY NUMBER: 361881309
	VISIT DATE: 11/09/2022

NARRATIVE

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If the residents chose not to take their medication, staff will log the refusal in their MAR record, staff will contact the resident’s doctor, staff will contact the resident’s responsible party, and staff will notify state licensing. LPA was not given information to collaborate the allegation.

For allegation, Staff is refusing to feed resident if they do not take medication:

LPA interviewed staff and residents, during interviews conducted LPA was informed that residents are not refused meals if they do not take their medications. If the residents chose not to take their medication, they are fed their meals, staff will log the refusal in their MAR record, the staff will contact the resident’s doctor, staff will contact the resident’s responsible party, and staff will notify state licensing. LPA was not given information to collaborate the allegation.

For allegation, Staff interfere with resident visiting:

LPA interviewed staff and residents, during interviews conducted LPA found that the residents are given privacy when visitors are present. The staff is only present when a responsible party or resident asks them to be present. LPA was not given information to collaborate the allegation.

For allegation, Staff do not maintain the facility at a comfortable temperature for residents:

LPA interviewed staff and residents, during interviews conducted LPA found that the residents are comfortable with the temperature in facility. LPA found that if a resident request a temperature adjustment the staff will adjust the settings within the required state regulated temperatures for heating and cooling. LPA viewed the temperature readings throughout the facility and found that the temperature was set within the state regulated temperatures for heating and cooling. LPA was not given information to collaborate the allegation.

For allegation, Staff is selling resident marijuana:

LPA interviewed staff and residents, during interviews conducted LPA found that staff have not attempted or sold marijuana to the residents. LPA was not given information to collaborate the allegation.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20221104153654

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GOLDEN HORIZON SENIOR CARE	FACILITY NUMBER: 361881309
	VISIT DATE: 11/09/2022

NARRATIVE

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Based on information found and discovered, LPA found that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the five (5) allegations listed above are deemed UNSUBSTANTIATED.

An exit interview was conducted, and this report was discussed and provided to Administrator Ebraheem Hamed, along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

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