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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366405789
Report Date: 06/05/2025
Date Signed: 06/05/2025 11:56:46 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
01/26/2022 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 18-AS-20220126153850
FACILITY NAME:GOLDEN GUEST HOMEFACILITY NUMBER:
366405789
ADMINISTRATOR:GALASINAO, ADELAIDAFACILITY TYPE:
740
ADDRESS:25070 DAISY AVENUETELEPHONE:
(909) 796-0882
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:6CENSUS: 5DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Administrator Adelaida GalasinaoTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident has open wound on their leg due to neglect
Facility did not meet resident's needs.
Facility staff did not ensure that resident's medication was refilled in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to deliver findings on the allegations mentioned. LPA met with Administrator Adelaida Galasinao and explained the purpose of the visit. The Department's investigation involved interviews and records review.

Regarding Allegation #1, Resident #1 (R1) was no longer living at the facility and was unable to be interviewed. LPA conducted four (4) resident interviews, all who informed LPA they have never had open wounds or bed sores due to neglect from staff. Based on staff interviews, R1 never had an open wound while living at the facility. LPA did not observe open wounds on residents.

Regarding Allegation #2, R1 was unable to be interviewed. LPA conducted four (4) resident interviews, all who agree staff meet their daily needs, receiving meals three (3) times a day and showers or bed baths weekly. LPA observed staff assisting residents and meeting their needs.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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 18-AS-20220126153850
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 GUEST HOME
FACILITY NUMBER: 366405789
VISIT DATE: 06/05/2025
NARRATIVE
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Regarding Allegation #3, Staff informed LPA R1 was on hospice care, and they took care of R1’s medication refills. LPA conducted 4 resident interviews all who stated staff assist with their medication refills. Staff informed LPA they assist with 4 out of 5 residents medication refills. 1 out of 5 resident medication refills is done by hospice.

Based on observation, interviews, and pertinent documents the allegations are unsubstantiated. An Unsubstantiated complaint means, that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with Administrator Adelaida Galasinao and a copy of this report was provided at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2