Golden City Home Care

Type of visit: Case Management - Annual Continuation

On 10/03/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Continuation Inspection and met with Administrator Antonia Dionisio. The facility is licensed to serve five (5) non-ambulatory residents and one (1) bedridden resident. The facility also has an approved hospice waiver for one (1) resident. The facility currently has two (2) residents receiving home health services and one (1) bedridden resident receiving hospice services. The annual licensing fees are current as of 10/02/2025. The home consists of four (4) resident rooms, two (2) bathrooms, kitchen, dining room, living room, laundry room, attached garage, and outdoor patio area. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, a non-skid mat was in place, and a hot water temperature warning sign is prominently placed in the residents’ bathroom. Continue to LIC809-C. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean, clear of hazards, and doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept locked. One fire extinguisher, last serviced May 2024 was observed in the hallway. Administrator tested all carbon monoxide and smoke detectors located in the home. Devices were functional. The last fire drill occurred on September 4, 2025. Four (4) staff records were reviewed, four out of four staff records had current first aid certificates, training records, and had required criminal record clearances or criminal record exemptions. Five (5) resident records were reviewed and, five out of five resident records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. Two medication records were reviewed. An exit interview was conducted, technical assistance provided, a copy of this report was provided to the Administrator Antonia Dionisio.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Required - 1 Year

On 09/26/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with Caregiver Rubelyn Dizon. LPA spoke with Administrator Antonia Dionisio over the phone. The Facility is licensed to serve five (5) non-ambulatory residents and one (1) bedridden resident. The facility also has an approved hospice waiver for one (1) resident. The facility is a single story home that includes: 4 resident rooms, 2 restrooms, kitchen, dining room, living room, laundry room, attached garage, and outdoor patio area. During today's visit, LPA conducted a tour of the physical plant, reviewed food supply, two medications, and four resident records. Due to insufficient time, an annual continuation visit is required. An exit interview was conducted with and a copy of this report was provided to Caregiver Rubelyn Dizon.the state’s words, verbatim · CDSS document, Sep 26, 2025

Allegation investigated: Suspicious death.

On 03/12/2025, Licensing Program Analysts (LPAs) Regina Cloyd and Jose Anguiano conducted a complaint investigation at the above facility to address the following allegations. LPAs met with Staff and Administrator Antonia Dionisio and explained the purpose of the visit. On 03/28/25, LPA Cloyd conducted a subsequent visit and met with Staff and Administrator Antonia Dionisio. On 05/22/25, LPA Cloyd conducted a subsequent visit to deliver findings for the seventh allegation. The investigation consisted of the following: On 03/12/2025, LPAs conducted resident, staff, and witness interviews, toured the facility, and reviewed resident records. On 03/28/25, LPA interviewed one witness and delivered findings for six out of seven allegations. Continue to LIC9099-C. Unsubstantiated Regarding the allegation "suspicious death,” it is being alleged that Resident #1 (R1) did not show any signs of illness other than being uncomfortable. It is alleged that R1 did not give the facility permission to be placed on hospice. Record review of R1’s physician’s report (02/22/25) revealed that R1 had cancer and poor health. Record review of hospice report revealed R1 was diagnosed with secondary malignant neoplasm of bone and R1 passed away peacefully. Death report revealed R1 was admitted to hospice at the same time R1 moved into the facility on 02/23/25 and died on 03/11/2025 11:59 AM. S1 indicated that R1 was discharged from the hospital and arrived to the facility very weak. On the day of arrival, he was placed on hospice. W1, R1’s son, indicated that R1 was already tired due to stage 4 terminal cancer. W1 indicated that R1 did not want to end up on hospice but R1 needed to be supervised due to declining health. Interview with Witness #3, from the hospice company, indicated that R1’s death was natural. Regarding the allegation “suspicious death," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted with Administrator Antonia Dionisio over the phone and a copy of this report was provided to the Staff Will Pison.the state’s words, verbatim · CDSS document, May 22, 2025 · control 11-AS-20250311171006

Allegation investigated: Resident was not accorded with privacy.

The investigation consisted of the following: On 03/12/2025, Licensing Program Analysts (LPAs) Regina Cloyd and Jose Anguiano conducted a complaint investigation at the above facility to address the following allegations. CCLD Staff met with Staff and Administrator Antonia Dionisio and explained the purpose of the visit. LPAs conducted resident, staff, and witness interviews, toured the facility, and reviewed resident records. On 03/28/25, LPA Cloyd met with Staff and Administrator Antonia Dionisio, interviewed the Administrator again and one witness, and delivered findings for six out of seven allegations. Regarding the allegation "Resident was not accorded with privacy,” it is being alleged that an unknown adult was present in the room while the caregivers were changing resident#1 (R1). It is alleged that the unknown adult was pointing to the resident’s private area and speaking in their native tough. Interview with Staff #1 (S1) indicated R1 had a roommate for 2-3 days but left. Continue to LIC9099-C. Substantiated Interview with Witness #3 indicated that R1 did have a roommate but changing the resident was not a part of W3’s scope of work. W3 indicated that W3 was not present at the facility while R1 was changed. S1 indicated staff cover R1 by standing on the side of the bed to block him. The roommate is just looking at the TV. S1 indicated that the unknown adult could have been S1’s husband’s son in training but he left the room. On 03/28/25 around 1:30 PM, S1 clarified that the husband’s son was only visiting the facility and accidently went towards the room to say hello. S1 indicated that S1 immediately redirected the son because he was unaware that R1 was being changed. Interview with Staff #2 (S2) indicated the door is closed and the roommate watches TV while the resident is being changed. Two out of two resident interviews indicated they receive privacy during changes. LPA Cloyd did not observe a divider for shared bedrooms. Regarding the allegation "Resident was not accorded with privacy,” based on interviews, the preponderance of evidence has been met therefore the allegation is Substantiated. Deficiencies were issued. An exit interview was conducted and plans of correction developed. A copy of this report, and appeals rights was reviewed and left with the Administrator Antonia Dionisio. Record review of Physician’s Report revealed R1 was on a soft diet and the preplacement appraisal revealed R1 had a poor appetite, should not have salt or sugar, and needs assistance with eating. Record review of hospice plan of care revealed R1 can have one can of Boost daily as needed, small and frequent meals or snacks, thin liquids such as broths, juices, and water and high-calorie, nutrient-dense supplements if R1 is not consuming adequate nutrients from the mechanical soft diet. Three out of three (S1-S3) staff interviews indicated adequate meals and soft foods are provided. Interview with Staff #1 (S1) indicated R1 started with regular meals because R1 said R1 could eat it. The facility chopped regular meat and vegetables into tiny pieces and mash potatoes was always included. Then S1 indicated R1 had difficulty swallowing so R1’s meals were pureed. S1 indicated R1 could not eat much and would only take a couple of bites. Interview with Witness #3 (W3) indicated that R1’s nutrient-dense supplements were protein shakes. LPAs observed five vanilla Boost in a box, a pot of stringed chicken and rice (soup-like) and LPA Cloyd observed one resident eating oatmeal for breakfast. Two out of two resident interviews indicated adequate and balanced meals are provided. Witness #1 (W1) had no concerns about the food. W1 knew that R1 could not eat much and was aware that R1 needed soft food. W1 indicated that when W1 tried to feed R1, R1 would not eat it or would spit it out. W1 indicated that W1 had no complaints about the food. Regarding the allegation “Staff did not provided adequate meals for resident while in care," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Resident was not provided with activities,” it is being alleged that Resident #1 (R1) was confined to his room and not provided with any activities. Record review of Preplacement appraisal revealed R1 loves to read and watch sports. Needs and Services Plan reveals the plan is to keep R1 doing range of motion activities every day to promote good circulation. Hospice Plan of Care revealed regular positioning and mobility, even if limited to bed exercises, shall be promoted for gastro-intestinal purposes. Interview with Staff #1 (S1) indicated staff cannot give R1 any activities because R1 was in bed and was weak. S1 indicated they try to do some motion exercises but R1 would eventually stop. Continue to LIC9099-C. Interview with Witness #3 (W3) indicated there were no orders for recreational activities nor exercises because R1 was really weak. If you move R1 a little bit, R1 would be in pain. Witness #1 (W1) indicated that R1 really enjoyed being bathe. W1 indicated that R1 was too tired to do the stretch bands and R1 lost dexterity so R1 could not move much. W1 indicated that the nurses indicated that the stretches would probably do more harm. Regarding the allegation “Resident was not provided with activities," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Allegation: Regarding the allegation "Staff did not address resident's change in condition,” it is being alleged that Resident #1 (R1) lost weight. Record review of Physician’s Report revealed R1 was 187 pounds as of 02/22/2025 and the status of R1’s physical health condition was poor. Staff #1 (S1) indicated R1 did not lose weight and if there is an issue, staff will call S1. Staff #2 (S2) indicated weight measurements were not taken. Witness #1 (W1) indicated that W1 could not tell if R1 lost weight, but the nurses were constantly at the facility. Interview with Witness #3 (W3) indicated W3 could not tell if R1 lost a lot of weight because R1 was only under hospice care for a few days. Prior to hospice care, the W1 and the doctor indicated that R1 lost a lot a weight. Regarding the allegation “Staff did not address resident's change in condition,” based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Staff do not effectively communicate with resident's responsible party,” it is being alleged that staff does not answer the phones or when they answer, they hang up. It is also alleged that Resident #1 (R1) was not allowed to receive an incoming call. Continue to LIC9099-C. Staff #1 (S1) indicated that sometimes you cannot hear the caller well or the caller ID comes up as SPAM. S1 indicated they give Staff #2 (S2) the phone. S1 indicated R1 was able to speak with callers. LPA Cloyd observed a text thread between S1 and Witness #4 (W4) around 8:34 AM about having R1 return W4’s call after repositioning. Witness #1 (W1) indicated that W1 did not have issues talking to R1 on the phone. W1 indicated that W1 did not have issues with communication. Two out of two resident interviews indicated they are able to receive incoming calls. LPA Cloyd observed Staff #2 (S2) answer the phone, say hello, and then hang up. LPA Cloyd observed the landline ringing frequently and S2 answering each call. LPA Cloyd called the landline and was able to communicate with S2. Regarding the allegation “Staff do not effectively communicate with resident's responsible party," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Allegation: Regarding the allegation "Staff do not provide resident with assistance in a timely manner,” it is being alleged that staff did not assist Resident #1 (R1) when R1 needed help. It is alleged that R1 was uncomfortable and needed to be repositioned. R1 was in great pain in back and R1’s head needed to be adjusted. It is alleged that staff would answer R1’s call for help and that caregivers would just look in R1’s room and walk by. Record review of R1’s hospice Plan of Care revealed regular turning should be done. Plan of Care also encouraged repositioning every two hours. Record review of R1’s repositioning schedule revealed R1 was repositioned about 4-5 times per day. On 03/10/25, the day before R1’s death, R1 was repositioned eight times. Interview with Staff #1 (S1) and Staff #2 indicated that residents are assisted in a timely manner. S1 indicated that there was one occurrence in which staff could not reposition R1 because R1 was on the phone with Witness #4 (W4). S1 indicated that R1 was repositioned once R1 ended call. Two out of two resident interviews indicated that their needs are provided for in a timely manner. Witness #1 (W1) indicated that W1 did not have concerns or issues about the care being provided to R1. Continue to LIC9099-C. Regarding the allegation “Staff do not provide resident with assistance in a timely manner," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Administrator Antonia Dionisio.the state’s words, verbatim · CDSS document, Mar 28, 2025 · control 11-AS-20250311171006

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(8) · Plan of correction due date: Apr 8, 2025

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (8) Privacy shall be afforded when care is provided. This requirement was not met as evidence by: Based on interview, Resident #1 (R1) was not provided privacy during changes which posed a potential personal rights risk to resident in care. Administrator immediately redirected the visitors because they were unaware that R1 was being changed.the state’s words, verbatim · CDSS document, Mar 28, 2025

Plan of correction: The Licensee will ensure that visitors do not enter residents' room while they are being changed. Licensee will provide evidence of a plan of correction to regina.cloyd@dss.ca.gov by the POC due date.

The state marks this report as 9 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 03/28/25, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced visit and met with Administrator Antonia Dionisio. The purpose of the visit was to investigate complaint 11-AS-20250311171006. During the visit, LPA Cloyd inquired about the type of activities she provides to the residents in care. The Administrator indicated that residents toss a ball for exercise and one resident likes to go outside to smoke. The Administrator showed LPA Cloyd a set of dominoes, art sketch board and art supplies, bingo, puzzles, and yarn for arts and crafts. No deficiencies were cited. An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and provided to the Administrator Antonia Dionisio.the state’s words, verbatim · CDSS document, Mar 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Antonia Dionisio , Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 residents ages 60 and above, Of which 5 non ambulatory and 1 bedridden. There is an approved hospice waiver for 1 resident. One of the residents is diagnosed with dementia. No residents are receiving home health or hospice care services. The facility does not handle any of the residents’ money. This home is a single story home consisting of: (4) resident bedrooms, (2) bathrooms, living room, kitchen with dining area, laundry room ,an attached garage and an outdoor shaded patio area. LPA Day and Administrator toured the Resident bedrooms and observed the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 111.1F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. Exit interview conducted with Antonia Dionisio, Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 6, 2024

Allegation investigated: Staff did not ensure facility was free from pests. Facility phone is in disrepair.

On 06/04/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s). LPA was greeted by staff and explained the purpose of the visit. The Administrator joined us shortly afterwards. The investigation consisted of the following: During today’s investigation, LPA toured the facility. Continue to LIC9099-C. Substantiated Allegation(s): Staff did not ensure facility was free from pests. The investigation revealed the following: Regarding the allegation "Staff did not ensure facility was free from pests,” it is being alleged that the facility has vermin in the kitchen area. LPA observed vermin at the entryway, on the kitchen counters with staff present, and on the kitchen floor. The Administrator indicated that pest control was initiated on 05/30/24 and that service would not resolve the entire pest issue right away. Record review reveals that the payment for pest control was processed on 05/30/24. Regarding the allegation “Staff did not ensure facility was free from pests,” based on interview and observation the preponderance of evidence has been met therefore the allegation is Substantiated. Deficiencies were issued. An exit interview was conducted and plans of correction developed. A copy of this report and appeals rights was reviewed and left with the Administrator Antonia Dionisio. Allegation(s): Facility phone is in disrepair. The investigation revealed the following: Regarding the allegation " Facility phone is in disrepair,” it is being alleged that the facility telephone is working but staff is unable to make or answer phone calls." LPA called the facility line and heard a call announcement through the television, but staff was unable to answer the call from the phones. LPA observed two facility phones with a “no power at base” notice and was unable to dial out. The Administrator indicated that her son plans to resolve the issue on 06/04/24 or on 06/05/24. Regarding the allegation “Facility phone is in disrepair,” based on interview and observation the preponderance of evidence has been met therefore the allegation is Substantiated. Deficiencies were issued. An exit interview was conducted and plans of correction developed. A copy of this report and appeals rights was reviewed and left with the Administrator Antonia Dionisio.the state’s words, verbatim · CDSS document, Jun 4, 2024 · control 11-AS-20240530152309

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: Jun 11, 2024

(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health and safety risk to residents in care. LPA observed vermin on the kitchen counters and on the kitchen floor.the state’s words, verbatim · CDSS document, Jun 4, 2024

Plan of correction: The Administrator immediately emailed the bi-monthly pest control service agreement processed on 05/30/24 to LPA Cloyd. The Administrator will provide evidence of service rendered between 06/04/24 and 06/11/24 to regina.cloyd@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 13, 2024

The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above which poses a potential safety risk to residents in care. LPA observed that staff could not receive incoming calls nor make outgoing calls due to powerless phone bases.the state’s words, verbatim · CDSS document, Jun 4, 2024

Plan of correction: The licensee will install new batteries/telephones inside of the facility and ensure that staff can receive incoming and make outgoing calls. The Administrator will provide evidence of correction to regina.cloyd@dss.ca.gov by the POC due date.