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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602369
Report Date: 10/11/2022
Date Signed: 10/12/2022 08:58:03 AM

Document Has Been Signed on 10/12/2022 08:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GOLDEN LIVING HEALTH MANAGEMENT, INC.FACILITY NUMBER:
374602369
ADMINISTRATOR:ROCIO GRANDAFACILITY TYPE:
740
ADDRESS:3223 DUKE STREETTELEPHONE:
(619) 222-1109
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY: 113CENSUS: 86DATE:
10/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator, Rocio GrandaTIME COMPLETED:
05:20 PM
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Licensing Program Analyst, (LPA), Natasha Persaud conducted an unannounced Case Management - Incident visit. LPA discussed the purpose of the visit with Administrator, Rocio Granda.

During today’s visit, LPA briefly toured the facility, requested records, and interviewed staff and residents. The facility self reported four incidents. Two incidents were regarding elopements for two different residents. The facility followed the required elopement procedures. Resident #1 (R1) eloped on 09/26/22 and will not be returning, as R1 is residing with a friend. Resident #2 (R2) eloped on 10/06/22 and was found by the police and brought back to the facility the same day, no injuries were sustained. The two other incidents involved theft. On 09/22/22 and 09/23/22, Resident #3 (R3) took items from another resident. On 09/28/22, Resident #4 (R4) reported items missing from their room.

Based on today’s inspection, no deficiencies were issued. An exit interview was conducted and a copy of this report along with Licensee's Appeal Rights (LIC 9058 01/16) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Residents #1, #2, #3, and #4]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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