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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881309
Report Date: 12/20/2023
Date Signed: 12/20/2023 01:39:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2023 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231107100241
FACILITY NAME:GOLDEN HORIZON SENIOR CAREFACILITY NUMBER:
361881309
ADMINISTRATOR:HAMED, EBRAHEEMFACILITY TYPE:
740
ADDRESS:1524 S EUCLID AVETELEPHONE:
(786) 564-3771
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY:22CENSUS: 19DATE:
12/20/2023
ANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee/Administrator Ebraheem HamedTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff made inappropriate comment towards resident.
Staff yelled at resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
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9
10
11
12
13
On 12/20/2023 at 01:30 PM, Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Ebraheem Hamed at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews and a review of pertinent documentation.

The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The first allegation indicates that Staff made inappropriate comment towards resident. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with residents indicated that no staff at the facility made inappropriate comment towards resident. Resident #1 (R1) reported to LPA Brown that no staff at the facility made inappropriate comment to R1.
***Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
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 56-AS-20231107100241
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: GOLDEN HORIZON SENIOR CARE
FACILITY NUMBER: 361881309
VISIT DATE: 12/20/2023
NARRATIVE
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 Staff interviews indicated that they never made inappropriate comment to a resident and no incident happened at the facility that staff made inappropriate comment towards a resident. During the visit on 12/14/2023, LPA Brown observed no staff making inappropriate comments to residents.

The second allegation indicates Staff yelled at resident. Interviews with residents pointed out that no staff at the facility yelled at them. Interviews with residents revealed that the staffs at the facility are all nice and all staffs are assisting them with their needs. Interviews with staffs revealed that no staff at the facility yells at resident and there's no incident that happened at the facility that a staff yelled at resident. R1 reported to LPA Brown that no staff at the facility yelled at R1. During the visit on 12/14/2023, LPA Brown observed no staff yelling at residents.

Based on interviews, observations and records review, the allegation Staff made inappropriate comment towards resident (Allegation #1) and Staff yelled at resident (Allegation #2) are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.


An exit interview was conducted, where this report (LIC9099) was discussed and provided to Licensee/Administrator Ebraheem Hamed.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC9099 (FAS) - (06/04)
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