366427602-11-22-2024-56-AS-EMAN-DKYPZZ-20250828114620

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366427602
Report Date: 11/22/2024
Date Signed: 11/22/2024 01:54:49 PM

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
11/21/2024 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20241121084941

FACILITY NAME:	GOLDEN YEARS RESIDENTIAL CARE		FACILITY NUMBER:	366427602
ADMINISTRATOR:	ALEXANDRU POPESCU		FACILITY TYPE:	740
ADDRESS:	7890 SAN BENITO STREET		TELEPHONE:	(909) 335-8335
CITY:	HIGHLAND	STATE: CA	ZIP CODE:	92346
CAPACITY:	6	CENSUS: 6	DATE:	11/22/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	House Manager- Megaswati Siby and Administrator- Irene Creignton		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff did not ensure resident’s diapering needs were met.
Staff did not inform resident’s physician of resident’s change of condition.
Staff did not provide adequate medication assistance to residents in care.
Staff refuse to call an ambulance for residents in care.
Staff threatened residents in care.
Staff did not ensure sufficient food items were available at the facility for residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with House Manager Megaswati Siby and explained the purpose of the visit. The Administrator Irene Creignton was contacted regarding today’s visit. The investigation consisted of staff interviews, resident interviews, record review and facility tour.

LPA Rico conducted 4 staff interviews and 3 resident interviews.

For the allegation, Staff did not ensure resident’s diapering needs were met.
During staff interviews, 4 out of the 4 staff stated they change their residents every two hours, or as needed. During residents’ interviews 3 out of the 6 residents stated staff members change their diapers but were unable to provided how often their diapers are changed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024

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-20241121084941

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 YEARS RESIDENTIAL CARE	FACILITY NUMBER: 366427602
	VISIT DATE: 11/22/2024

NARRATIVE

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For the allegation, Staff did not inform resident’s physician of resident’s change of condition.

During staff interviews, 4 out of the 4 staff stated residents’ physician are contacted for change of condition and their responsible party. In addition, 3 out of the 4 staff stated for emergencies changes they will call the paramedics.

For the allegation, Staff did not provide adequate medication assistance to residents in care.During staff interviews, 4 out of the 4 staff stated they assist residents with medications and follow physician order. During resident interviews 3 out of the 6 residents stated they receive their medication. LPA Rico verify medication were dispense properly and documentation matched current medications.

For the allegation, Staff refuse to call an ambulance for residents in care. During staff interviews, 4 out of the 4 staff stated they have not refused to call the ambulance. In addition, 4 out of the 4 staff stated they will also contact the responsible party and notified hospice. During residents’ interviews, 3 out of the 6 residents stated they are allowed to call 911 and allowed to seek medical attention when needed.

For the allegation, Staff threatened residents in care .During staff interviews, 4 out of the 4 staff stated they have not threatened a resident in care and have not witness other staff threatened their residents. During residents’ interviews, 3 out of the 6 residents stated they have not been threatened by staff and feel safe at the facility.

For the allegation, Staff did not ensure sufficient food items were available at the facility for residents in care. During staff interviews, 4 out of the 4 staff stated they have sufficient food supplies for residents in care. In addition, 3 out of the 4 staff stated the Administrator will order food deliveries through the week. During facility tour, LPA observed sufficient food supplies for all residents.

Based on the evidence found during the investigation, the six (6) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. 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 House Manager Megaswati Siby.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024

LIC9099 (FAS) - (06/04)

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