366427602-11-22-2024-56-AS-EMAN-DKYQ22-20250828114620

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366427602
Report Date: 11/22/2024
Date Signed: 11/22/2024 01:57:39 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 prevent residents from engaging in inappropriate interactions.
Staff yelled at residents in care.
Staff did not assist residents that sustained falls.
Staff do not have a fire evacuation plan at the facility.
Staff do not have an infection control plan at the facility.
Staff are not following reporting requirements.
Staff left residents unattended.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (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.

For the allegation, Staff did not prevent residents from engaging in inappropriate interactions.

During staff interviews, 4 out of the 4 staff stated all residents do not engage in inappropriate interactions because majority of the residents prefer to stay in their rooms, during activities residents get along, and the facility has two to three caregivers per shift to provide care and supervision. During residents’ interviews, 3 out of the 6 residents stated they have not been touched or felt uncomfortable by other residents.

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 yelled at residents in care. During staff interviews, 4 out of the 4 staff stated they have not yelled at their residents. 4 out of the 4 staff stated they have not witnessed a staff member yell at their resident. During resident interviews, 3 out of the 6 residents stated they have not been yelled by staff and feel safe at the facility.

For the allegation, Staff did not assist residents that sustained falls. During staff interviews, 4 out of the 4 staff stated they are trained to assist residents with falls and will assist if a resident has a fall. During record review, LPA verified staff have received training to assist residents.

For the allegation, Staff do not have a fire evacuation plan at the facility. During staff interviews 4 out of the 4 staff stated the facility has a fire evacuation plan at the facility. During record review, LPA observed facility’s fire evacuation plan.

For the allegation, Staff do not have an infection control plan at the facility. During staff interviews, 2 out of the 4 staff stated the facility has an infection control plan. During record review, LPA observed facility’s infection control plan.

For the allegation, Staff are not following reporting requirements. During staff interviews, 4 out of the 4 staff they follow reporting requirements. 3 out of the 4 staff stated they will notify the Administrator, family members and hospice. The Administrator stated they are responsible to submit Special Incident Reports to Community Care Licensing.

For the allegation, Staff left residents unattended. During staff interviews 4 out of the 4 staff stated they have not left the residents unattended. 3 out of the 6 staff stated they have not been left alone at the facility.

Based on the evidence found during the investigation, the seven (7) 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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