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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881309
Report Date: 10/04/2024
Date Signed: 10/04/2024 10:48:22 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
09/30/2024 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20240930131922
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: 22DATE:
10/04/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Administrator Ebraheem HamedTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff are not properly addressing rodents in the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Raquel Hernandez and Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPAs met with Administrator Ebraheem Hamed and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and facility tour.

For the allegation, Facility staff are not properly addressing rodents in the facility.

LPA Hernandez conducted three (3) staff interviews and six (6) resident interviews.

During residents interviews 3 out of the 6 residents stated they have seen rodents in the facility and kitchen. 3 out of the 6 residents also stated that staff removes the rodents with mouse traps. In addition, 2 out of the 6 residents stated they have not seen any rodents at the facility. During staff interviews, 3 out of the 3 staff stated they have not seen any rodents or bugs in the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024
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-20240930131922
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GOLDEN HORIZON SENIOR CARE
FACILITY NUMBER: 361881309
VISIT DATE: 10/04/2024
NARRATIVE
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On 10/4/2024 Licensing Program Analysts (LPAs) Raquel Hernandez and Mary Rico inspected the facility and observed mouse traps located in the kitchen and in the office room. LPAs did not see any rodents at the facility, and no rodents droppings. Futhermore, Administrator Ebraheem Hamed stated the mouse traps are for precaution and there hasn't been a rodent seen at the facility.

During record review, LPA Hernandez observed the facility receives monthly pest control. LPA received copies of pest control invoices.

Based on the evidence gathered during today’s investigation, the allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Ebraheem Hamed.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2