Golden Age Living 1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hiratsuka arrived unannounced at the facility to conduct an unannounced annual visit. LPA toured with Caregiver Judith Gayle. Caregiver Camille Davis was present during this visit. LPA and Caregiver conducted a tour of the interior and exterior of the facility to ensure the health and safety of the residents in care. Areas toured included but not limited to: five residents bedrooms, staff room, bathroom, laundry room, backyard and the common areas. LPA observed facility to have two days of perishable and seven days of nonperishable foods. LPA observed facility having a designated space for sharps, toxins, and medications. File review revealed Applicant and other individuals working at the facility are fingerprint cleared. LPA observed facility to be clean, safe, sanitary and in good repair. Today's visit LPA observed the following: -all staff working have criminal record clearance and associated to this facility -one staff file was not present during this visit. LPA was informed the staff member was brought over from another facility the Licensee operates and a copy of the file hasn't been brought over yet. Regulations require a file for each staff person working to be available for review by Community Care Licensing Division upon request. -one resident does not have a file at the facility. Regulations require a file for each resident to be available for review by Community Care Licensing Division upon request. As a result of today's inspection, deficiencies cited. Please see LIC 809-D. Exit interview and a copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 29, 2026

Allegation investigated: Staff is not fingerprint cleared to provide care and supervision to residents. Staff emotionally abuse residents. Staff does not treating residents with respect. Staff not keeping residents personal information confidential.

Licensing Program Analyst Kerry Hiratsuka conducted this unannounced complaint visit to deliver the results of the allegation above. LPA reviewed facility records and conducted interviews. Each side interviewed stated different version of events. LPA was able to interview three of four residents at the time and LPA was unable to determine the events. Complainant did not give any identifying information or examples of the incidents. LPA did confirm current staff do have criminal record clearance. LPA interviewed staff. LPA cannot determine the alleged incidents based on lack of information. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Caregiver stated she was uncomfortable to sign report and declined to sign. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 22, 2026 · control 59-AS-20251218112025

Allegation investigated: . Staff intimidated a resident in care. 2. Staff yelled at a resident in care. 3. Staff did not provide a variety of meals to a resident in care.

Licensing Program Analyst (LPA) Kerry Hiratsuka conducted this unannounced complaint visit to deliver the results of the allegation above. LPA reviewed facility records and conducted interviews. 1. Resident stated a staff person waived a knife in their face. A third party heard the resident say a staff person was waiving a knife in their face. The staff person (S1) stated S1 was cutting meat at the counter and the resident was sitting on in the dining area, on the other side of the table away from the S1. S1 stated they put the knife down on the counter when they turned around to talk to the resident. There were no other residents or staff in the area to confirm or deny the incident. Because each side has their version of events and there are no direct witnesses LPA cannot prove or disprove the allegation. Caregiver stated she was uncomfortable to sign report and declined to sign. Unsubstantiated 2. Staff stated they didn't verbally abuse the residents. There were no direct witnesses to confirm or deny the incident occurred. A witness stated they heard S1 yelling at the resident. Recordings were submitted to LPA. LPA cannot determine if the staff person was yelling at the resident or attempting to explain what was occurring to the witness and had to talk loudly to be heard. Staff stated they don't yell at the resident and were the ones getting yelled at. Other residents interviewed stated the staff do not yell at them and they haven't heard any of the staff yelling at anyone else. Because each side has their version of events LPA cannot prove or disprove the allegation. 3. Resident told a staff person they didn't want what was being prepared for lunch and wanted something else. Resident stated they didn't what they asked for. Staff person stated the resident initially wanted one thing that had to be cooked in the oven and then stated later the resident wanted something else at the same time. Staff person stated the resident had to chose one or the other because one of the items was going to take awhile to cook. Staff stated they would make the second choice for lunch and then the other for dinner since it was going to take awhile to make. Resident stated they didn't get anything. Staff stated the resident was given the second request for lunch. There were no direct witnesses in the room to confirm or deny the incident occurred. Because there is not enough evidence the incidents occur or did not occur, the allegation cannot be proved or disproved. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Caregiver stated she was uncomfortable to sign report and declined to sign.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 59-AS-20260112110037

Allegation investigated: Staff verbally abused resident while in care.

Licensing Program Analyst Kerry Hiratsuka conducted this unannounced complaint visit to deliver the results of the allegation above. LPA reviewed facility records and conducted interviews. Each side interviewed stated different version of events. Staff stated they didn’t verbally abuse the residents. There were no direct witnesses to confirm or deny the incident occurred. Because there is not enough evidence the incidents occur or did not occur, the allegation cannot be proved or disproved. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 22, 2025 · control 59-AS-20251113121941

Allegation investigated: Staff did not ensure resident's incontinence care is being met. Staff did not respond to resident's call button in a timely manner.

On December 4, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the allegation of the complaint above. LPA met with staff and explained the purpose of the visit. For the allegations, Staff did not ensure resident's incontinence care is being met, and Staff did not respond to resident's call button in a timely manner, LPA conducted extensive interviews. Interviews conducted revealed that staff serve dinner at approximately 4:00 PM and "wraps up" residents at approximately 8:00 PM. Interview conducted with Licensee, confirmed dinner is typically served at 4-4:30 PM. Interview conducted with staff (S1) revealed that five out of six residents required incontinence care. Last depend change is completed at 8:00 PM. Interview conducted with resident (R1) revealed that staff are "good at changing" in the day but if an incontinence accident occurs in the middle of the night, staff does not respond for changing. R1 stated this typically occurs around midnight and staff will assist with changing around 7:00 AM. Please continue on LIC 9099-C. Substantiated LIC 9099-C Interview conducted with resident (R3) revealed that incontinence care at night does not exist. R3 stated R3 requires full assistance with incontinence care by staff, last depend change occurs after dinner around 5:00-6:00 PM. R3 reported no assistance is available around 8:30 PM. Interview conducted with resident (R4) revealed that there have been multiple occasions where R4 soiled themselves in the middle of the night. R4 stated R4 tries to use call lights at night for emergencies only since staff are sleeping, but majority of the time, staff does not wake up to the call light as it is located in the kitchen away from the staff room which is separated by a fire door. Interview with R4 further revealed that there was a night where call light was triggered approximately at 10:00 PM but staff did not wake up to the call so R4 was left sleeping in wet depends which leaked to the bedding until morning. Based on the information obtained, the allegations are SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following allegation cited above is substantiated; however, no deficiencies issued as facility was cited for similar allegations substantiated on December 4, 2025 for Complaint 59-AS-20251028090844. Exit interview conducted and a copy of the report and appeal rights was providedthe state’s words, verbatim · CDSS document, Dec 4, 2025 · control 59-AS-20251125162613

Allegation investigated: Staff did not respond to residents call button. Staff left resident in a soiled diaper for a long period of time.

On December 4, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the allegation of the complaint above. LPA met with staff and explained the purpose of the visit. For the allegations, Staff did not respond to residents call button, and staff left resident in a soiled diaper for a long period of time, LPA conducted extensive interviews. Interviews conducted revealed that staff serve dinner at approximately 4:00 PM and "wraps up" residents at approximately 8:00 PM. Interview conducted with Licensee, confirmed dinner is typically served at 4-4:30 PM. Interview conducted with staff (S1) revealed that five out of six residents required incontinence care. Last depend change is completed at 8:00 PM. S1 stated there are two residents in care that tends to be awake throughout the night while the others sleep. Please continue on LIC 9099-C. Substantiated LIC 9099-C Interview conducted with resident (R1) revealed that staff are "good at changing" in the day but if an incontinence accident occurs in the middle of the night, staff does not respond for changing. R1 stated this typically occurs around midnight and staff will assist with changing around 7:00 AM. Interview conducted with resident (R3) revealed that incontinence care at night does not exist. R3 stated R3 requires full assistance with incontinence care by staff, last depend change occurs after dinner around 5:00-6:00 PM. R3 reported no assistance is available around 8:30 PM. Interview conducted with resident (R4) revealed that there have been multiple occasions where R4 soiled themselves in the middle of the night. R4 stated R4 tries to use call lights at night for emergencies only since staff are sleeping, but majority of the time, staff does not wake up to the call light as it is located in the kitchen away from the staff room which is separated by a fire door. Interview with R4 further revealed that there was a night where call light was triggered approximately at 10:00 PM but staff did not wake up to the call so R4 was left sleeping in wet depends which leaked to the bedding until morning. R4 stated recently it has been one caregiver working at the facility, with one caregiver working periodically on-call, when the facility used to be staffed with two caregivers working at all times. Based on the information obtained, the allegations are SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following allegations cited above are substantiated, please see LIC9099-D. Exit interview conducted and a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Dec 4, 2025 · control 59-AS-20251028090844

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(2) · Plan of correction due date: Dec 19, 2025

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not comply to the section cited above as resident interviews revealed that at night there is minimal assistance by staff for incontinence care which poses a potential risk for residents in care.the state’s words, verbatim · CDSS document, Dec 4, 2025

Plan of correction: Licensee is to submit a plan of how facility will ensure incontinent residents are routinely checked, especially the night. This plan is to be submitted to LPA by December 19, 2025. Failure to complete plan of correction by due date will result to $100 civil penalty per day until received/corrected.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Dec 19, 2025

87411 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 is not met as evidenced by: Based on interviews conducted, Licensee did not comply as call lights for incontinence care are often not attended at night which poses a potential risk for residents in care.the state’s words, verbatim · CDSS document, Dec 4, 2025

Plan of correction: Licensee is to submit a plan to LPA of how facility will ensure residents needs are met at all times as call lights are not responded to at night. This plan is to be submitted to LPA by December 19, 2025. Failure to complete plan of correction by due date will result to $100 civil penalty per day until received/corrected.

Type of visit: Case Management - Deficiencies

On November 6, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct a complaint investigation when LPA observed the following deficiencies. LPA met with staff and explained the purpose of the visit. Today's visit, LPA was conducting interviews and observed medications to be in R1's bedroom. LPA observed laxative and a bottle of Tylenol to be present in the room. Upon file review of R1's LIC 602, it revealed that R1 is unable to administer own medication and unable to store own medication. When LPA and staff walked to the garage to look for personal hygiene product and paper towels for residents in care, LPA observed facility did not have any paper towels available for resident usage. LPA was informed it was a frequent issue that there was no paper towel and/or hand towels for usage. During the inspection of the garage, LPA observed boxes of residents overflow medications. LPA was informed this is where medications are centrally stored. LPA informed staff that all medications in R1's room is to be removed and to be centrally stored and locked. LPA informed staff that the garage is not an adequate space for medication as garage is not locked where residents can easily access medications. As a result of today's inspection, deficiencies cited. Please see LIC 809-D. Exit interview and a copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(1)(B) · Plan of correction due date: Nov 7, 2025

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (B) Any medication is determined by the physician to be hazardous if kept in the personal possession of the person for whom it was prescribed. This requirement is not met as evidenced by: Based on observation and file review, Licensee did not comply as R1 is unable to store own medication but laxative and tylenol was observed in the room which poses an immediate risk for residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Medications were removed from R1's bedroom and centrally stored immediately. Licensee is to audit all residents bedrooms to ensure there are no medications in their rooms as all residents in care are unable to store own medications. Notification of completion is due within 24 hours on November 7, 2025. Failure to correct by plan of correction due date may result to a civil penalty of $100 per day until received.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Nov 7, 2025

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, Licensee did not comply as the centrally stored medications are not in a locked space which poses an immeidtae risk for residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee is to relocate all medications to a centrally stored safe and locked space. Proof of the relocation is to be submitted to LPA within 24 hours on November 7, 2025. Failure to correct by plan of correction due date may result to a civil penalty of $100 per day until received.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(C) · Plan of correction due date: Nov 10, 2025

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. This requirement is not met as evidenced by: Based on observation and interview, Licensee did not comply as facility did not have any paper towels and/or hand towels available for residents in care until a resident's family member arrived with paper towels which poses a potential risk for residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee is to purchase adequate supply of hand towels and/or paper towels for residents in care. Licensee is to submit proof of purchase to LPA by November 10, 2025. Failure to correct by plan of correction due date may result to a civil penalty of $100 per day until received.

Type of visit: Collateral

Licensing Program Analyst (LPA) Cassie Yang arrived to conduct a collateral visit regarding a complaint at another facility. The issue does not have anything to do with this facility. No deficiencies cited. Exit interview.the state’s words, verbatim · CDSS document, Oct 9, 2025

Allegation investigated: Staff do not respond to residents' calls for assistance in a timely

On September 23, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to investigate the allegation cited above. LPA met with caregivers and explained the purpose of the visit. Today's investigation, LPA conducted interview with Administartor, four residents in care and two caregivers. For the allegation of staff does not respond to residents calls for assistance timely, LPA conducted an interview with R1, R2 and R3 which revealed that staff assist residents as needed. R3 stated they need full assistance with everything and does not have any concerns getting staff's attention as they are attentive. Interview conducted with R4 revealed they have to wait when calling for assistance but staff does come to assist. Interview conducted with S1 and S2 revealed they have not witnessed other caregivers not assisting to residents call. S2 stated if it takes a little longer it is due to staff assisting to other residents in care. Based on information above, the department concluded that the allegation is unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview and copy of report provided. Unfoundedthe state’s words, verbatim · CDSS document, Sep 23, 2025 · control 59-AS-20250915111530

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Pre-Licensing inspection utilizing the inspection tool. LPA met with caregiver and explained the purpose of the visit. Additionally, LPA spoke with Applicant on the phone and explained the purpose of the visit. There are four residents in care with zero residents on hospice services. LPA and Caregiver conducted a tour of the interior and exterior of the facility to ensure the health and safety of the residents in care. Areas toured included but not limited to: five residents bedrooms, staff room, bathroom, laundry room, backyard and the common areas. LPA observed fire extinguisher present with service date of June 8, 2024. LPA informed Caregiver that fire extinguisher should be renew servicing soon to stay in compliance. LPA observed facility to have two days of perishable and seven days of nonperishable foods. LPA observed facility having a designated space for sharps, toxins, and medications. File review revealed Applicant and other individuals working at the facility are fingerprint cleared. LPA observed facility to be clean, safe, sanitary and in good repair. LPA spoke with Applicant on the phone who stated she would like to waive Comp III as this will not be their first community care facility. Based on today's inspection, the pre-licensing inspection has passed. Applicant has satisfied all requirements in accordance to per Title 22, California Code of Regulations. CAB will be notified accordingly of licensure. Exit interview and a copy of report was provided.the state’s words, verbatim · CDSS document, May 15, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 4 COMP II Participant: Muamoudou Soumahoro, Managing Member/Administrator Interview Method: Telephone interview On 4/1/25, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 1, 2025