Golden Haven Guest Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with staff Martha Guzman and explained the reason for the visit. Shortly after Administrator Richard Villaverde arrived and assisted with the visit. Physical Plant was toured, residents files and medication records were reviewed, staff files records reviewed, and food supply was inspected. The facility is licensed for fifteen (15) residents over the age of 60. The facility is a single story building. LPA toured the home and inspected ten (10) resident bedrooms, one (1) staff room, 3.5 bathrooms (1 bathroom was observed in the office), kitchen, dining room, living room, office, 2 storage rooms, and laundry room. LPA toured the facility. All indoor and outdoor passageways were free of obstruction and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the back of facility. LPA observed laundry detergent, cleaning supplies are locked and inaccessible to residents. The kitchen was inspected. There is sufficient perishable and non-perishable food. Cooking knifes are locked and inaccessible to residents. LPA toured residents rooms. All bedrooms were furnished with required furniture. The bathrooms were observed to be clean, operational. The hot water temperature was tested at the residents bathroom and measured at 149.9 degrees F which is over the Title 22 regulation. LPA observed the centrally stored medication area to be locked and inaccessible to residents. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. The facility has a sprinkler system with wired alarm. 5 fire extinguishers are present in the facility and are fully charged. LPA observed the facility had the required carbon monoxide detectors and are operable. Continue 809C LPA reviewed 3 residents and 3 staff records. Residents' records were found to be complete and current. Staff files were reviewed, and documentation noted that facility staff maintain a criminal record clearance and associated to the facility. LPA randomly chose some residents' medications to review. Medications are documented properly and stored appropriately. Last Fire Drill completed on 04/15/26. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Administrator.the state’s words, verbatim · CDSS document, May 18, 2026

Allegation investigated: Staff hit resident.

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Administrator Richard Villaverde and explained the reason for the visit. During today’s visit, LPA obtained a copy of the resident and staff rosters, reviewed R-1’s file and obtained relevant documentation, interviewed Administrator Staff 1 (S1) - Staff 4 (S4), SC from SGPRC and interviewed Resident 1(R1) - Resident 3 (R3). Continue 9099C Unsubstantiated Allegation: Staff hit resident. It was alleged that facility morning staff, who assisted with the medication, hit R1 and R1 was crying. LPA interviewed the Administrator and Staff. Administrator stated that was unaware of what had happened until Police Officer from Azusa Police Department arrived and informed about the incident that allegedly happen on 04/16/26. Police Officer came to the facility twice, on 04/16/26 and 04/17/26 for wellness check and interviewed R1 and staff. The Police Officer gave a case number with no report. Copy of Police case number was provided to LPA. The administrator stated an internal investigation was conducted. Administrator interviewed all residents including R1 and staff. The administrator stated that residents and staff denied that staff hit R1. Administrator indicated that when they asked R1 if any staff hit them, R1 claims that S1 hit them. When Administrator asked how it happened, R1 cannot explain or give details of what happened. R1 changed the topic and started to cry saying that they missed their family. During today’s visit, LPA interviewed S1 who denied hitting R1 or other residents. Also S1 stated that they not assisting with R1’s morning medications. Other staff interviewed did not witness S1 hitting R1 or any other residents. They stated they treat residents with respect and would not hit a resident. R1 was interviewed and responded yes that someone hit them but mentioned name which not listed on the facility staff roster. However, R1 could not provide any details regarding incident. Interviewed residents indicated they have not been hit by anyone and have not observed S1 or any other staff hitting R1 or other residents. Interviewed Administrator, staff and residents mentioned that R1 often cries for no reason, but sometimes R1 tells them that they missed their family. At the time of visit LPA collected and reviewed documentation pertaining to R1, including IPP ( Individual Program Plan). Per IPP R1 exhibits emotional outbursts (crying) about one or two times a week without any reason. LPA spoke with R1's Service Coordinator who indicated R1's medical diagnosis could contribute to R1 crying often; as well as R1 missing their mother. SC stated that they don't have any concerns about R1 at this time. Based on record / file review and interviews conducted, investigation revealed: 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, therefore the allegation is unsubstantiated. Exit interview was conducted with the Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 24, 2026 · control 28-AS-20260417110525

Allegation investigated: Lack of staff supervision resulting in resident sustaining injury.

The purpose of this Amended Report 3/20/2026 is to remove confidential information and remove repeated statement.Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint visit to deliver findings pertaining to the above-mentioned allegation. LPA met with Administrator Richard Villaverde and explained the reason for the visit. Today 3/13/2026 a collateral visit at 9:30 AM was conducted at Resident R1's Day Program. Resident R1 was interviewed shortly thereafter at 10:00 AM. The initial visit was conducted on 2/27/2026 and included the following: Licensing Program Analyst (LPA) Glenn Trueman conducted a complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Richard Villaverde and explained the reason for the visit. At today's visit 2/27/2026 the following was done: Resident and Staff Roster were submitted. Files for Resident R1 and Resident R2 were reviewed. Admission Agreement, Physician's Report and Individual Program Plan were submitted for Resident R1. Unsubstantiated In regards to the allegation Lack of staff supervision resulting in resident sustaining injury, based on interviews conducted and information gathered Resident R1 stated that it was not staff who had pulled on R1's arm. Revealed that staff responded quickly when another resident had pulled on R1's arm. Said they jumped right in. Stated that R1 feels safe at the facility. Spoke with Harbor Regional Service Coordinator who stated they were given information from the Day Program and on 2/17 the SIR was closed. Said on 2/18 R1 showed a bruise the size of a golf ball. 2/19 Stated that she called the Administrator and said the bruise looked a week old and was healing. The picture of the bruise looked small and old. Information gathered from Day Program for Resident R2 which stated that R2 does have the behavior of pulling on other residents and the staff try to jump in, but R2 is quick and they get there ASAP. Will separate her from others. Spoke with Administrator Richard Villaverde who stated that R1 and R2 have lived here 40 years without incident. Said R2 gets excited and pulls on residents arms. Stated R2 is just tapping, but other residents don’t like it. Administrator told R1 he will talk to R2 and also told staff to watch closely. Had staff also separate R1 and R2. Spoke with Resident's R1-R6 who all stated that staff are very good. They reacted quickly to what the problem was. They moved R2 to a different location away from others. R1 and R2 both stated they are treated well by staff. Information gathered from R1's Day Program which stated that the bruise looked like it was healing and was not a fresh bruise. Staff all stated that they have been watching closely all residents. Stated the Administrator told them to keep a close eye on R2 and behaviors R2 might act out on. Said there has never been any abuse and R1 and R2 have been here 40 years and never a problem,. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted with the Administrator. A copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Mar 13, 2026 · control 28-AS-20260222203120

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Nune Margaryan and Blanca Gonzalez conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPAs met with Richard Villaverde, Administrator and explained the reason for the visit. Physical Plant was toured, residents files and medication records were reviewed, staff files records reviewed, and food supply was inspected. The facility is licensed for fifteen (15) residents over the age of 60. The facility is a single story building. LPAs toured the home and inspected nine (9) resident bedrooms, one (1) staff rooms 3.5 bathrooms, kitchen, dining room, living room, office, storage room, and laundry room. There is only one entrance being utilized at the facility, all required posters were posted at the entrance. LPA toured the facility. All indoor and outdoor passageways were free of obstruction and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the back of facility. LPAs observed laundry detergent, cleaning sprays and Bleach sprays at the outdoor activity area were unlocked and accessible to residents. The kitchen was inspected. There is sufficient perishable and non-perishable food. Cooking knifes are locked and inaccessible to residents. LPAs observed that kitchen roll out drawers are broken and layer of grease on the oven door of the stove. LPAs toured residents rooms. All bedrooms were furnished with required furniture. The bathrooms were observed to be clean, operational. The hot water temperature was tested between 124.5 degrees F which is over the Title 22 regulation. Continue 809C LPAs observed the centrally stored medication area to be locked and inaccessible to residents. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. The facility has a sprinkler system with wired alarm. 5 fire extinguishers are present in the facility and are fully charged. LPAs observed the facility had the required carbon monoxide detectors and are operable. LPA reviewed 3 residents and 3 staff records. Residents' records were found to be complete and current. Staff files were reviewed, and documentation noted that facility staff maintain a criminal record clearance and associated to the facility. LPA randomly chose some residents' medications to review. Medications are documented properly and stored appropriately. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Martha Guzman.the state’s words, verbatim · CDSS document, Apr 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Administrator Richard Villaverde and explained the reason for the visit. Physical Plant was toured. The facility is licensed for fifteen (15) residents over the age of 60 of which 10 may be non-ambulatory. The facility is a single-story building. LPAs toured the home and inspected nine (9) resident bedrooms, two (2) staff rooms 3.5 bathrooms, kitchen, dining room, living room, office, storage room, and laundry room. LPA Gutierrez conducted a tour of the facility, reviewed records, and interviewed 2 staff and 1 client. The following were observed: Client bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen. Each bedroom has a smoke detector which were tested bedroom #9 was observed not working technical violation (TV) was given Administrator replaced smoke detector at time of visit. There is a carbon monoxide detector located in the hallway and another in the living room area. The bathrooms were observed to be clean and equipped with grab bars and non-skid mats. Bathroom #1 was observed to have a leak under sink when hot water was turned on. The hot water was between 106.6 to 115.3 degrees which is within the required 105 - 120 degrees. There is a fire extinguisher located in the kitchen and in the laundry room and they are fully charged. Sharps are locked in the kitchen and inaccessible to residents. Cleaning supplies and toxins are locked in laundry room and inaccessible to residents. First Aid kits were fully stocked with current manuals. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the clients located in the back patio. Passageways and exits are free of obstruction. SEE LIC 809C Three (3) staff files were reviewed and included Criminal clearance record, CPR/training, and health screening with TB. Five (5) client files were reviewed and included physicians report, TB clearance, and individual program plan (IPP)report. Last fire/earthquake drill was conducted in April of 2024. Infectious control plan was reviewed. Two (2) staff and (1) client was interviewed. Five (5) out of (5) client medications were reviewed. Medications are centrally stored and locked MAR log is used. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Richard Villaverde.the state’s words, verbatim · CDSS document, May 9, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.