374604841-3-27-2026-08-AS-APAO-DT7STM-20260416140943

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604841
Report Date: 03/27/2026
Date Signed: 03/27/2026 07:43:26 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2026 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20260323115338

FACILITY NAME:	GREAT GOLDEN SENIOR LIVING		FACILITY NUMBER:	374604841
ADMINISTRATOR:	DORVILUS, ROSE		FACILITY TYPE:	740
ADDRESS:	496 HIGHTREE PL		TELEPHONE:	(619) 394-9731
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY:	6	CENSUS: 4	DATE:	03/27/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rose Dorvilus, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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- Facility staff did not meet the care needs of resident(s)

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility, LPA investigated and delivered findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by caregiver Myrta Mompremier. LPA stated the purpose of the visit and reviewed the findings of the complaint with Administrator Rose Dorvilus, and caregiver Mompremier.

The Department’s investigation consisted of interviews with residents, staff, outside source, records review of relevant documents pertinent to this investigation, and LPA observations. On March 23, 2026, it was alleged that the facility staff did not assist resident(s) out of bed.

According to the facility’s documentation, resident #1 (R1) is cognitively sound and is able to follow directions, instructions, and communicate their self-care needs. They may take their own medications. R1 is non-ambulatory and, according to the Physician’s Report (LIC602), requires assistance with repositioning and transfers. They do have an assistive device for transferring and using their wheelchair.
[Continuation on LIC9099-C]

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

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 4

Control Number 08-AS-20260323115338

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GREAT GOLDEN SENIOR LIVING	FACILITY NUMBER: 374604841
	VISIT DATE: 03/27/2026

NARRATIVE

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[Continuation of LIC9099: p.2 of 3]

Resident #2’s (R2) LIC602 indicates that they have a cognitive condition but has the ability to communicate their self-care needs and follow instructions. Their physical health states that they need assistance with repositioning and transferring. They do have an assistive device to assist with transferring. Due to their cognitive ability, they are unable to manage their own medications, lack hazard awareness, and are disoriented.

Resident #3’s (R3) LIC602 shows that they are cognitively sound, but require assistance with repositioning and transferring. R3’s self-care capacity demonstrates that they are able to communicate their needs and follow instructions. They do have episodes of confusion and lack hazard awareness. R3 is unable to manage their own medication.

According to the LIC602 for resident #4 (R4), they do display mild cognitive impairment and are confused/disoriented, but has the ability to follow instructions and communicate their needs. Their LIC602 shows that they require assistance with motor impairment and is non-ambulatory. They require assistance with self-care needs and are unable to manage their own medications.

An overall interview with residents expressed that they desired to come out of their rooms. Interview with R1 said that they were told by the owner that they are allowed to come out of their room three times per week, but they have not been out in several days. They would like to be out of their room but need assistance with doing so. R1 also had issues with staff not providing their medications accurately. Interview with resident #2 (R2) preferred to have the ability to leave their bed to the living room. LPA inquired about the number of times they had left the room in the last 5 days, and R2 said that they had not left their room. Since they have been here, they have only left once. Interview with R3 said that they do have a Lyft, but not all the staff know how to use it. They are not often left in their room and would like to go, but the staff are busy. They mentioned that they have sat out in a chair possibly once but would like to go into the living room. Interview with resident #4 (R4) said that the facility at times have a shortage of workers and it takes a toll on them. They are supposed to get out of bed daily but there is no one to help the caregivers. Interview with staff #1 (S1) said that they did not have sufficient time to assist residents with the transfer. An outside source #1 (OS1) did corroborate that they observed resident in their room and R3 has mentioned that staff do not take them out of their room.

[Continuation on LIC9099-]

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 08-AS-20260323115338

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GREAT GOLDEN SENIOR LIVING	FACILITY NUMBER: 374604841
	VISIT DATE: 03/27/2026

NARRATIVE

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[Continuation of LIC9099-C: p.3 of 3]

On March 27, 2026, LPA was at the facility and observed that there was insufficient staff to meet the residents' care needs. Residents were interviewed and expressed their desire to be out of their assigned rooms. Throughout LPA’s visit, the residents were not assisted with transferring onto their wheelchairs to come out of their rooms, until about 4:15 PM when one resident was assisted out. During the visit, LPA was left alone for approximately 20 minutes, and during that time, a hospice nurse came, and the staff was out of vicinity not attending with calls or the door when a hospice care staff arrived. LPA was provided a 31 day refusal log - Refusal to sit in chair / Go Outside log. The facility said that they only had this log sheet for resident in room #3 for the month of February 2026. Later LPA reviewed the medications for one resident which were not provided to resident as prescribed by their physician. Numerous medications were missed.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff, resident and outside source interviews, records reviewed, and LPA observations, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099-D page of this report.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Administrator Rose Dorvilus via telephone, and caregiver Myrta Mompremier. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to caregiver Mompremier at the conclusion of the visit. The signature below confirms the receipt of these documents.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20260323115338

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GREAT GOLDEN SENIOR LIVING	FACILITY NUMBER: 374604841
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/27/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/17/2026 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 (a) Personnel Requirements - General - (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs … this requirement was not met as evidenced by:	1 2 3 4 5 6 7	The administrator agreed to assist with the care needs of residents and come in TWTH from 9am - 2pm; and MF from 9am - 12pm; and submit a schedule for themself along with scheduling medication training for staff by POC due date 04/17/2026.
	8 9 10 11 12 13 14	Based on records review, interviews, and documentation,and LPA observations staff did not provide R1, R2, R3, and R4 with transferring out from their bed, and medications not being administered as precribed which posed an immediate personal rights risk to 4 of 4 residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4