Golden Legacy Elderly Care

Allegation investigated: The Administrator is not present at the facility for a sufficient amount of time.

On July 7, 2026, at 1:30 PM, Licensing Program Analysts (LPAs) Avelina Martinez and Sulma Lopez arrived unannounced at the facility to deliver complaint findings for the above allegations. LPAs met with Torika Cowa and Diana Garcia and explained the purpose of the visit. During this investigation, LPAs conducted interviews, file reviews, and facility inspections. Based on file reviews, it was learned that the administrator was present during 1 out of 5 facility inspection visits. Per the Licesnsee, the facility currently does not have an appointed Administrator resulting in significant lack of oversight on medication administration and the maintenance of facility records. LPAs observed the following concerns: medication refill supply is being stored with expired medication, not maintaining medication records (MAR), staff not refilling medication in a timely manner, and are not storing them properly,and medication destruction not being completed. Continued... Substantiated Per the Licensee they reported they did not attempt misrepresent the authenticity of LIC 602A. Due to the above noted information, 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, and therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility. Also, during a medication administration records review, it was learned that R1 missed their daily dose of Dulcolax 5 MG due to S1 not being properly trained on knowing where refill medication supply was being stored. As a result of this investigation, the Department finds these allegations to be Substantiated. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D page, per Title 22 Regulations. An exit interview was conducted, and a copy of this LIC 9099 report, LIC 9099-D page, and LIC appeal rights document were provided to the facility.the state’s words, verbatim · CDSS document, Jul 7, 2026 · control 27-AS-20260211142756

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Jul 21, 2026

87405(a) Administrator - Qualifications and Duties:...administrator...shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility...This requirement was not met as evidence by: based on observation, interviews, and file reviews, the Licensee did not ensure that the admin was present at the facility a sufficient amount of hours to complete management/administration duties. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: The Administrator shall be present in the facility 40 hours per week starting July 07, 2026. LIC 500 Personnel report shall be emailed to LPA Martinez by July 21, 2026 by 5:00 PM. Licensee will appoint a new administrator by POC date July 21, 2026.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Avelina Martinez and Sulma Lopez arrived at this facility unannounced on July 07, 2026, at 1:30 PM to conduct a case management visit. LPAs met with Torika Cowa and Diana Garcia and explained the purpose of the visit. The purpose of the visit today is in response to the following learned deficiencies: Incidental Medical and Dental Care. It was learned that the facility is not refilling resident medication in a timely manner, resulting in missed medications. Facility staff are also not maintaining the Medication Administration Record (MAR) accurately. Staff do not initial the MAR indicating that the medication has been administered. Additionally, there are medications present in the facility that are not being documented on the MAR. Medication destruction is not being completed. Based on this case management inspection, the facility will be cited the following deficiencies Incidental Medical and Dental Care 87465 (a)(6) and 87465 (4). These deficiencies can be found on the 809-D page.the state’s words, verbatim · CDSS document, Jul 7, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(6) · Plan of correction due date: Jul 21, 2026

87465(a)(6) Incidental Medical and Dental Care- A plan for incidental medical and dental care shall be developed by each facility...When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility This requirement was not met as evidenced by based on interviews, observation, and file reviews, the licensee did not ensure that facility staff were maintaining accurate medication administration records. This posed a potential health risk for residents in care.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: Facility staff will conduct a medication audit by a medical professional by POC date July 21, 2026. Facility staff agrees to email LPA Martinez a copy of the medication audit report by POC date July 21, 2026 by 5:00pm.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(a)(4) · Plan of correction due date: Jul 21, 2026

87465(a)(4) Incidental Medical and Dental Care- A plan for incidental medical and dental care shall be developed by each facility...The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by based on interviews, observations, and file review, the licensee did not ensure that facility staff were assisting residents with medication administration as required. This posed a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: Facility staff will conduct a medication audit by a medical professional by POC date July 21, 2026. Facility staff agrees to email LPA Martinez a copy of the medication audit report by POC date July 21, 2026 by 5:00pm.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(i)(1-4) · Plan of correction due date: Jul 21, 2026

87465(i)(1-4) Incidental Medical and Dental Care- Prescription medications… which are not returned to the issuing pharmacy… or which are otherwise to be disposed shall be destroyed in the facility by the facility administrator and one other adult who is not a resident... This requirement was not met as evidenced by: based on interviews, observation, and file reviews, the licensee did not ensure medications were properly disposed and destructed. This posed a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: Facility staff will conduct an in service medication destruction training by a medical professional by POC date July 21, 2026. Facility staff agrees to email LPA Martinez a copy of the in service training document by POC date July 21, 2026 by 5:00pm.

Type of visit: Case Management - Other

On February 20, 2026 at 11:00 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit. LPA Martinez met with Diana Garcia and explained the purpose of the visit. The purpose of today's visit is to discuss an Administrator change. LPA Martinez requested the following documents: Letter from the Licensee requesting to appoint a new administrator to the facility. Copy of current administrator certificate Any documentation that meets the education and/or experience requirement LIC 308 Designation of Facility Responsibility LIC 200 signed by the Licensee or Designee. (update Administrator section) LIC 500 Personnel Report LIC 501 Personnel Record Fingerprint and association documentation (Guardian Report) Please email document to LPA Martinez by February 23, 2026, by 5:00 PM.the state’s words, verbatim · CDSS document, Feb 20, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio was met by facility staff Kertia Bryan, and explained the purpose of the visit. LPA Valerio called Licensee Diana Garcia and left a voicemail. LPA Valerio sent an email to licensee notifying her of LPA's arrival. After LPA Valerio conducted the facility tour, interviewed residents, and interviewed staff, LPA was met by Licensee Diana Garcia. LPA Valerio toured the facility too ensure compliance with Title 22 regulations. Upon arrival, LPA Valerio observed one staff on shift and six residents. Staff was preparing breakfast in addition to assisting residents with activities of daily living. To ensure each resident was given a fresh plate of food, staff assisted the resident one by one as each resident woke up for the day. Breakfast was pineapples, strawberries, blueberries, ham breakfast sandwich with toasted buttered bread, scrambled eggs, water, and hot coffee. LPA observed three residents awake and three residents sleeping at the start of the visit. LPA Valerio observed resident bedrooms to be fully furnished and free from odors. Resident bathrooms were observed to fully stocked with hygiene supplies. The fire extinguisher was last service on 03/03/2025. The facility thermostat was set to 67 degrees, which was within the regulatory range. The facility door alarms were observed to be in working condition. The facility common areas were observed to be clean, fully furnished, free from odors, and organized. LPA Valerio observed the exterior plant. LPA observed facility fences to be in good repair and no emergency exits were obstructed. Continues on LIC 809 - C... Continued from LIC 809 LPA Valerio observed the kitchen area. The facility was observed to have an adequate food supply and an emergency supply of food. Inside the refrigerator, LPA observed boxes of insulin on the side of the fridge next to food items. There was a lock box located inside the fridge; however, it was full. Licensee stated she will get a bigger lock box for the medications that need to be refrigerated. During the visit, licensee ordered a bigger lock box and showed LPA that it would be delivered today. Technical assistance was given for this observation. LPA Valerio reviewed three (3) staff files and three (3) resident files. Staff files were up to date with required training. Resident files were up to date with required annual documentation and assessments. LPA Valerio and Licensee Diana Garcia discussed the staff to resident ratio and meeting all the residents needs. Licensee Diana stated she is working on getting another staff hired to work in the home, in addition to the live in care staff. LPA Valerio provided guidance on Title 22 regulations and answered Licensee Diana questions regarding volunteers. LPA Valerio requested the following documentation: Administrator Certificate, Administrator CEU/training, LIC 500, LIC 308, LIC 610D, and copy of liability insurance. Per California Code of Regulations (CCR) - Title 22, technical advisories were provided to licensee Diana Garcia. No citations were issued during today's visit. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 10, 2025

Allegation investigated: Staff are not administering resident's medication as prescribed

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegation. LPA Lund met with Care Staff Asena Motubula and explained the reason for the visit. LPA Lund called Licensee Diana Garcia who could not make the visit because of an emergency and gave permission for Care Staff Asena Motubula to sign required paperwork. Census: 5 Staff are not administering resident's medication as prescribed - LPA Lund reviewed facility records and interviewed staff. Residents (R1) LIC602A dated 3/5/2025 has a list of medications that R1 is prescribed. LPA Lund reviewed the medications and the medication that R1 stated that is supposed to be taking is not one of the prescribed medications on the list. LPA Lund was not able to interview R1becasue R1 is no longer a resident of the facility and doesn’t the whereabouts of R1. Unsubstantiated Based on facility records reviewed, and interviews with staff on the information provided, it was unclear if staff are not administering resident's medication as prescribed, therefore the allegation was deemed UNSUBSTANTIATED. As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of 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. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Jun 27, 2025 · control 27-AS-20250318163724

Allegation investigated: Unlawful Eviction

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegation. LPA Lund met with Care Staff Asena Motubula and explained the reason for the visit. LPA Lund called Licensee Diana Garcia who could not make the visit because of an emergency and gave permission for Care Staff Asena Motubula to sign required paperwork. Census: 5 Unlawful Eviction - LPA Lund reviewed facility records and interviewed staff. On 3/28/2025 Resident (R1) signed acknowledgment of self-discharge. The facility didn’t serve R1 with any notices. LPA Lund interviewed staff who stated that R1 wanted to leave the facility. LPA Lund was not able to interview R1becasue R1 is no longer a resident at the facility. Unsubstantiated Based on facility records reviewed, and interviews with staff on the information provided, it was unclear if unlawful eviction, therefore the allegation was deemed UNSUBSTANTIATED. As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of 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. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Jun 27, 2025 · control 27-AS-20250411131803

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to do a case management visit. LPA Lund met with Care Staff Asena Motubula and explained the reason for the visit. LPA Lund called Licensee Diana Garcia who could not make the visit because of an emergency and gave permission for Care Staff Asena Motubula to sign required paperwork. Census: 5 LPA Lund reviewed facility records that indicate that the is Staff (S1) is the Administrator for the facility. LPA Lund interviewed Staff and residents in care. LPA Lund also spoke with S1 who had not worked at the facility since mid-April 2025. When speaking with S1, was not aware that S1 was the Administrator for Golden Legacy Elderly Care & Golden Legacy Elderly Care 11. Licensee Diana Garcia never notified S1 that S1 was the Administrator for both facilities. Licensee also never notified community care licensing or turned in the required paperwork to change the administrator when S1 stop working at the facility in mid-April 2025. Deficiencies were cited during today's visit. Exit interview held and copy of the report and a copy of the appeal rights left.the state’s words, verbatim · CDSS document, Jun 27, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Jun 30, 2025

All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility..... This requirement was not met as evidenced by: S1 who was the Administrator on record has not worked at the facility since mid-April 2025. which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 27, 2025

Plan of correction: Licensee Diana Garcia will turn in required paperwork for Administrator.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87207 · Plan of correction due date: Jul 7, 2025

False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met as evidenced by: Licensee Diana Garcia never notified S1 that S1 was the Administrator for both facilities.which poses an immediate health, safety and/or personnel rights risk.the state’s words, verbatim · CDSS document, Jun 27, 2025

Plan of correction: Licensee Diana Garcia will go over the regulation and email LPA Lund stating she understands the regulation.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct an annual required inspection. LPA met with facility staff Kimberly Sloan, and explained the purpose of the visit. Administrator Diana was contacted via phone and arrived later during the visit. LPA and facility staff toured the physical plant to ensure compliance with Title 22 regulations. LPA observed resident bedrooms to be clean and free from odors. Staff bedroom was observed to be clean and fully furnished. Water temperature reads 105° F in the bathroom and room temperature reads 73° F. LPA observed the facility to have adequate food supply. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher had a last check on 05/24/2024. Medications, sharps, and toxins were locked away and inaccessible to residents in care. No emergency exits were observed to be obstructed. Residents were observed eating breakfast, which was waffles, sausage, scrambled eggs, and coffee, watching the Olympic games on television, playing solitaire, and completing ADLs. Staff was observed cleaning the facility, preparing meals, completing chart documentation, and engaging with the residents. LPA Valerio reviewed two (2) staff and three (3) resident files. Resident files were observed to be complete with required annual documentation and care plans. Staff files were observed to be complete The last emergency drill was conducted on 05/20/2024. LPA Valerio requested the following annual documentation be sent by 08/02/2024: LIC 500, LIC 308, LIC 610, and copy of Liability Insurance Per California Code of Regulations (CCR) - Title 22, no deficiencies were observed during today's visit. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 29, 2024