Golden Home for Seniors

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual required inspection. LPA Valerio met with facility staff, and explained the purpose of the visit. LPA Valerio was later met by Administrator Ma Magnolia Tolon. LPA Valerio toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed the common area lobby area, television lounge area, staff desk, and dinning room. The areas were observed to be fully furnished and free from cluttered items. LPA Valerio did not observe any hazardous items accessible to residents in care. LPA Valerio observed one resident sitting in the living room on the recliner. LPA Valerio observed two dogs, which were pets for two of the residents. LPA Valerio observed the facility to be at comfortable temperature. The facility kitchen area was observed to have fresh fruit available for the residents. The facility was observed to have a food supply that met the requirements of two days of perishable and seven days of non-perishable food items. Resident bedrooms were observed to be fully furnished, free from odors, and clean. LPA Valerio observed resident bathrooms. Resident bathrooms were observed to have a shower chair, skid matts, hand soap, paper towels, hand rails, and toilet paper. LPA Valerio observed the backyard to have an area for outdoor seating, gardening, and a storage, which was utilized for old wheelchairs. LPA Valerio observed three (3) staff and three (3) resident files. Files were observed to be up to date. LPA Valerio requested the following: LIC 500, LIC 308, 610, and copy of liability insurance. No deficiencies were cited today. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 16, 2026

Type of visit: Required - 1 Year

On 08/14/2025 unannounced annual inspection was made to this facility by Licensing Program Analyst (LPA) Sommer Hayes. The LPA identified themselves and the purpose of the visit and asked to speak to the Designated Facility Administrator (DFA). LPA was met by Administrator, Ma Magnolia Tolon, and a brief interview followed. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 residents. The current census is 6. LPA Hayes toured the facility with the Designated Facility Administrator (DFA), Ma Magnolia Tolon. The kitchen was accessible to residents and clean and sanitary. The LPA observed 7 days of non-perishable and 2 days of perishable food supplies. There is enough clean plates, cups and bowls and cutlery to meet capacity. Opened packages in the refrigerator were dated appropriately. Staff were observed assisting residents with activities of daily living (ADLs), cleaning the home and engaging with resident in care. Residents were observed working on a puzzles, eating, watching television, and in their bedrooms. Water temperature measured 107 degrees F within regulation between 105- and 120-degrees F at faucets accessible to residents. Fire extinguishers inspected were charged on 05/06/25 by River City Fire and was in compliance. A dual smoke detector/carbon monoxide in hallway was tested and working. There was enough lighting in all common areas, resident rooms, and hallways. A first aid kit was observed containing a first aid manual, tweezers, scissors, gauze and Band-Aids. Continued on 809-C LPA Hayes reviewed 6 resident files and 2 staff records during this visit. Medication was centrally stored and secured. The medication administration record (MAR) was reviewed and found to be complete with accurate documentation of administered medications provided to residents. LPA Hayes observed the backyard of the facility to be clean and free of hazards. There was a shaded area for residents to enjoy. Fencing was in good repair. There were no bodies of water. The facility living room was clean and free of obstruction. The temperature reading was 74 degrees Fahrenheit per Title 22 regulations. The seating is efficient for the number of residents in this facility. LPA Hayes requested the following annual documents for the facility file: LIC 500 Personnel Report, LIC 308 Designation of Responsibility, LIC 610 Emergency Disaster Plan, LIC 999 Facility Sketch, Copy of Administrator’s Certificate. Per California Code of Regulations (CCR) - Title 22, 0 deficiency are being cited. An exit interview was held, and a copy of the report was provided to Designated Facility Administrator, Ma Magnolia Tolon.the state’s words, verbatim · CDSS document, Aug 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 7/24/24 at 1:00pm. Administrator certificate expires 5/5/25. LPA met with Ma Magnolia Tolon, Administrator and stated the purpose of todays visit. The facility is licensed for a capacity of 6 non- ambulatory of which 1 maybe bedridden in room and 4 may receive hospice care services.There is 0 resident receiving hospice care services nor bedridden at this time. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. The temperature inside the facility was observed to be at 75*F which is within the required range of 68-85*F. The hot water temperature was measured at 110.8*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution. LPA observed 3 residents and 1 staff files during this visit. LPA observed 2-day perishables and 7-day non-perishables. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-Submit Emergency Disaster Plan LIC610-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Current Liability Insurance-(if applicable)Submit Infection Control Plan-Current Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Jul 24, 2024

Allegation investigated: Resident was physically assaulted while in care by an unknown adult Staff did not provide a safe and comfortable environment for resident Resident was disrespected by two unknown adults while in care

AMENDED TO ADD ADDITIONAL CONTEXT LICENSEE AGREED Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude the investigation of the above mentioned allegations on 4/11/24 at 12:30pm. LPA met with William James Tolon, Administrator and stated the purpose of the visit. Magnolia Tolon, Administrator arrived within 15 minutes to assist with todays visit. During the visit on 1/22/24, LPA requested and obtained a copy of the following documents: Personnel Report LIC500, a list of staff with contact numbers, Staff work schedule, Resident roster with responsible party contact numbers, any facility progress notes for resident #1 (R1), Identification And Emergency Information (LIC601), Physician report (LIC602), Admission Agreement, Administrator Certificate(s). During this visit, LPA conducted interviews of 6 residents of which 1 had a family member present, and 4 staff during this visit. Regarding allegation(s), "Resident was physically assaulted while in care by an unknown adult", LPA obtained information through interview with R1’s Responsibly party that R1 was not assaulted, and that the complainant made it up. RP stated that when staff was assisting the resident, they bumped heads. R1 gets anxious because the nurse always comes late which put R1 in a panic and the blood pressure went up. LPA conducted interviews with R2 who stated the staff are treating them well at this facility out of the last 3 homes R2 has resided. "Staff did not provide a safe and comfortable environment for resident", LPA obtained information through interview with R1’s Responsibly party that R1 is safe at the facility but the doctor wanted a higher level of care. LPA conducted interviews with R2 who stated the staff are helpful at the facility. R3 confirmed liking being at the facility."Resident was disrespected by two unknown adults while in care", LPA obtained information through interview with R1’s Responsibly party that R1 was treated well at the facility by the wonderful staff. LPA conducted interviews with R2 who stated the staff are helpful at the facility and assists so much so that R2 can walk and write again. R3 and R4 stated staff are nice and there are no bad words used in the facility and no one was hit by anyone. R5 and R6 stated in their opinion this is about R1 who was disruptive and has now relocated. R7 stated raised voices by staff has not been heard since admittance into the facility.All interviews of R2-R7 corroborate and concur that these allegations are false which includes the interview of the family.Based on interviews and a review of R1's facility file, and facility daily notes the allegations are deemed Unfounded."The allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint." Per California Code of Regulations, no deficiencies were observed or cited. Exit interview held, and a copy provided. Unfounded Based on interviews and a review of R1's facility file, and facility daily notes the allegations are deemed Unfounded. "The allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint." Per California Code of Regulations, no deficiencies were observed or cited. Exit interview held, and a copy provided.the state’s words, verbatim · CDSS document, Apr 11, 2024 · control 27-AS-20240119100521