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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604314
Report Date: 10/28/2022
Date Signed: 10/31/2022 07:46:56 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2021 and conducted by Evaluator Liliana Silveira
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20210528090011
FACILITY NAME:GOLDEN HOUSE RESIDENCE #21FACILITY NUMBER:
374604314
ADMINISTRATOR:KARATAS, ELOISA C.FACILITY TYPE:
740
ADDRESS:21 VIA ALTA VISTATELEPHONE:
(760) 295-4141
CITY:BONSALLSTATE: CAZIP CODE:
92003
CAPACITY:6CENSUS: 6DATE:
10/28/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrators Eloisa and Yusuf KaratasTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Facility staff did not receive training in equipment use
Facility did not follow incident reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Liliana Silveira conducted a complaint investigation visit to deliver findings for the above-mentioned allegations. LPA Silveira met with Eloisa and Yusuf Karaitas and shared the findings.

The Department’s investigation consisted of interviews, observations, and records review. On 05/28/21, it was alleged that facility staff did not receive training in equipment use, specifically regarding a Hoyer lift for resident transfers. A records review and interviews with staff revealed that facility staff had received equipment training in the use of the Hoyer lift by a medical equipment company. There was insufficient evidence to support the allegation.

On 05/28/21 it was also alleged that the facility did not follow incident reporting requirements after a fall incident. Interviews with staff denied the allegation and outside sources revealed that there were no (CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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 08-AS-20210528090011
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: GOLDEN HOUSE RESIDENCE #21
FACILITY NUMBER: 374604314
VISIT DATE: 10/28/2022
NARRATIVE
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witnesses or evidence to corroborate that an incident involving a facility resident had even occurred during this time. Interviews with the Administrator, staff and outside sources also revealed that the name of an individual mentioned in the complaint allegation was not recognized by anyone and was not a staff employee associated with the facility. Therefore, there was insufficient evidence to support this allegation. Due to lack of corroborating evidence, the findings regarding the above allegations were established to be unsubstantiated. This finding means although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

LPA Silveira conducted an exit interview with Eloisa Karatas. At the time of the exit interview Eloisa was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) and signature on this report acknowledges receipt of the rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2