Golden Manor Rest Home

Type of visit: Annual/Random

On August 30, 2026, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced 1-year required annual visit using the inspection tool. Due to technical difficulties, LPA Richard could not generate the electronic inspection tool and instead used a printable/PDF version. LPA Richard used the inspection tools for all program types. Upon arrival at the Golden Manor Rest Home, LPA Richard verified that the facility has a mitigation plan report on file. The facility is licensed to serve 98 residents, of whom 42 may be non-ambulatory. There are currently no hospice waivers or bedridden residents at the facility. LPA met with Judith Montoya, and we both toured the facility's interior and exterior grounds. The facility’s designated visitation areas include the front patio, courtyard, front living room, and the resident’s bedroom. LPA observed required postings throughout the facility. The facility does not support residents with dementia and does not have a memory care unit. A room was inspected. Beds and bedding were in good condition, adequate lighting was provided, and storage for residents’ personal belongings was observed. Furniture in common areas is clean. No weapons were found on the premises. The resident bathrooms were checked, and sufficient liquid soap and paper towels were available. Toilets and water faucets were functioning properly, grab bars were secure, and the shower was free of mold or mildew. The water temperature in the resident’s room was measured at 112.3 degrees Fahrenheit, which is within the regulations for the common area. The facility maintained a comfortable temperature overall. A fire drill was conducted on June 12, 2026. All facility fees are up to date. LPA toured the kitchen area and observed a two day supply of perishable food and a seven (7)-day supply of non-perishable food. Knives and toxins were locked and stored separately. Centrally stored medications were in their original containers and kept secure, locked, and inaccessible to residents in care. The First Aid kit was available and inaccessible to residents. Several fire extinguishers were observed throughout the facility. Outside grounds were toured, and no bodies of water were observed. Walkways around the facility were clear of hazards. Common areas were clean and free of hazards; doorways were free of obstruction. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was provided to the Assistant Administrator, Judith Montoya.the state’s words, verbatim · CDSS document, Aug 30, 2026

Allegation investigated: Licensee does not ensure that facility elevator(s) are in good repair.

On 10/16/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an subsequent visit to change the finding determination issued on 08/13/25 on the above allegation. LPA met with Office Staff Maggie Romero and spoke with Assistant Administrator Judith Muro over the phone and the purpose of the visit was explained. Investigation consisted of the following: On 08/13/2025, LPA obtained Personnel Report (dated 04/16/25), Register of Residents, and a business card of the former elevator company. LPA interviewed Staff #1 – 2, Witness #1 – 2, and Residents #1 – 7, and observed the elevator. On 09/19/25, LPA received an Elevator Invoice (02/16/25) and application for elevator plan check and inspection (paid 09/15/25). On 10/06/25, LPA interviewed Witness #2. Note: LPA left a voicemail for Witness #1 and Resident #6 was unavailable. Continue to LIC9099-C. Unsubstantiated Investigation revealed the following: Allegation: Licensee does not ensure that facility elevator(s) are in good repair. Record review of elevator invoice (02/16/25) revealed that a portion of the deposit for a new elevator had already been paid. Record review of the application for elevator plan check and inspection was paid on 09/15/25. On 10/06/25, interview with Elevator Vendor (W2) indicated that the elevator was working in February 2025 but not properly. W2 indicated W2 would visit the facility to service the elevator whenever there was an issue. W2 indicated that the project started 1 – 2 months after the elevator invoice date. On 08/13/25, interview with the Administrator indicated that the elevator has been down for at least four weeks and W2 was waiting for a particular piece. W2 indicated that W2 anticipates the permit to be approved next week and the elevator to be completed in two months. Six out of six resident interviews (R1-R5, R7) indicated they take the stairs and are still able to receive services. Regarding the allegation, “Licensee does not ensure that facility elevator are in good repair,” based on record review and interviews, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Judith Muro over the phone and a copy of this report was provided to Office Staff Maggie Romero.the state’s words, verbatim · CDSS document, Oct 16, 2025 · control 11-AS-20250806090400

Allegation investigated: Staff are financially abusing residents.

On 10/16/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an subsequent visit to gather information regarding the above allegation. LPA met with Staff Maggie Romero and spoke with Assistant Administrator Judith Muro over the phone and the purpose of the visit was explained. Investigation consisted of the following: On 09/19/2025, LPA obtained Personnel Report (dated 04/16/25), Register of Residents (04/23/25), Resident Theft and Lost Record (Rev. 10/89), R1’s Receipt (04/14/25), R1’s Resident Statement and Acknowledgement document (signed 04/14/25) and R1’s Unusual Incident Report (dated occurred 04/14/25). LPA interviewed Staff #1 – 9 and Residents #1 – 8. On 10/16/25, LPA interviewed Staff #10 and reviewed one resident’s record. Note: Resident #9 declined to be interviewed. Continue to LIC9099-C. Unsubstantiated Investigation revealed the following: Allegation: Staff are financially abusing residents. Regarding the allegation, “Staff are financially abusing residents,” it is being alleged that Staff #1 (S1) has stolen money from R1, R5 – R8. It is being alleged that Staff #10 (S10) and other staff members has taken money from residents’ rooms and possibly their mail. Review of incident report (04/14/25) revealed R1 reported lost money and staff helped R1 look for it but could not find it. Review of receipt revealed the facility paid R1 $2,000.00 on 04/14/2025. The Administrator, S1, and S10 indicated that R1 has been the only resident to complain about staff stealing money. W1 was aware of R1’s complaint and indicated that the Administrator would reimburse R1. Four out of seven staff interviews (S3 – S9) indicated that residents have not complained lost or stolen money. Five out of eight resident interviews (R1 – R8) indicated that they have not had money lost or stolen. R5 indicated that money went missing when R5 went to the emergency room, it was reported to the office, and R5 was redirected to follow up with Veterans Affairs but did not. S10 indicated that R5 has not complained about lost money. R6 – R8 denied the allegation. Regarding the allegation, “Staff are financially abusing residents,” based on record review and interviews, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Judith Muro over the phone, technical assistance provided, and a copy of this report was provided to Office Staff Maggie Romero.the state’s words, verbatim · CDSS document, Oct 16, 2025 · control 11-AS-20250912153247

Allegation investigated: Licensee does not ensure that facility elevator(s) are in good repair.

On 08/13/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an initial visit on to gather information regarding the above allegation. LPA met with Med-Tech Cristina Revolorio and the purpose of the visit was explained. LPA spoke with Administrator Mark Ingber over the phone. Investigation consisted of the following: On 08/13/2025, LPA obtained Personnel Report (dated 04/16/25), Register of Residents, Resident #6-7's medical assessment, R6's Identification and Emergnecy Infor, and a business card of the former elevator company. LPA interviewed Staff #1 – 2 (S1-S2), Witness #1 – 2 (W1-W2), and Residents #1 – 7 (R1-R7), and observed the elevator. Note: LPA left a voicemail for W1 and R6 was unavailable. Investigation revealed the following: LPA observed an “out of service” notice on the elevator. Interview with the Administrator indicated that the elevator has been down for at least four weeks and the vendor is waiting for a particular piece. Continue to LIC9099-C. Substantiated The Vendor (Witness #2) indicated that W2 anticipates the permit to be approved next week and the elevator to be completed in two months. Six out of six residents (R1 – R5, R7) agree with the allegation. Regarding the allegation, “Licensee does not ensure that facility elevator are in good repair,” based on observation and interviews, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. An exit interview was conducted, plans of correction developed, and a copy of this report with the appeal rights was provided to the Administrator Mark Ingber.the state’s words, verbatim · CDSS document, Aug 13, 2025 · control 11-AS-20250806090400

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Aug 26, 2025

87303 Maintenance and Operation (a) The facility shall be... in good repair at all times... This requirement was not met as evidence by: LPA observed an "out of service" notice on the elevator and interviews indicated that it has been out of services for at least four weeks which poses a potential safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 13, 2025

Plan of correction: The Administrator will submit a plan of correction detailing the elevator contrsuction plan and project completion date, its impact on the residents, copy of notice sent to residents and authorized representatives, and copy of the permits to regina.cloyd@dss.ca.gov by the POC due date.

Type of visit: Case Management - Deficiencies

On 08/13/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted a case management - deficiencies visit and met with Med-Tech Cristina Revolorio. The purpose of the visit was to conduct an investigation on complaint #11-AS-20250806090400 and while there, LPA noticed deficiencies. Record review of Resident #1 medical assessment revealed that R1 is nonambulatory (dated 03/28/2024) and R1 lives on the second floor. Record review of the facility's license revealed that the first floor is for non-ambulatory residents only. Deficiencies are being cited according to California Code of Regulations, Title 22, see LIC 9099D. An exit interview was conducted, plans of correction developed, and a copy of this report with the appeal rights was provided to Administrator Mark Ingber.the state’s words, verbatim · CDSS document, Aug 13, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(1) · Plan of correction due date: Aug 14, 2025

(a) All facilities shall maintain a fire clearance ... Prior to accepting or retaining any of the following types of persons, the... licensee shall notify ... obtain an appropriate fire clearance approved by ... the State Fire Marshal. (1) Nonambulatory persons. This requirement was not met as evidence by: Record review of R1's medical assessment indicated R1 as non-ambulatory and the facility's license revealed that the first floor is for non-ambulatory residents . LPA observed R1 room on the second floor. This poses an immediate safety risk to resident in care.the state’s words, verbatim · CDSS document, Aug 13, 2025

Plan of correction: The Administrator will either relocate R1 and any other non-ambulatory residents from the second floor to the first floor, have R1 reassessed by a medical doctor for a current ambulatory status, or submit a plan of correction to regina.cloyd@dss.ca.gov by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(h)(1) · Plan of correction due date: Aug 26, 2025

87463 Reappraisals (h) The licensee shall request that all residents receive an annual routine visit ... once every twelve months, either in person or by video appointment. (1) Documentation of the annual routine visit... shall be added to the resident's record. This requirement was not met as evidence by: Record review of R1's medical assessment was conducted on 03/28/2024. This poses a potential health risk to resident in care.the state’s words, verbatim · CDSS document, Aug 13, 2025

Plan of correction: The Administrator will submit evidence of correction to regina.cloyd@dss.ca.gov by the POC due date.

Type of visit: Case Management - Annual Continuation

On 6/18/2025, At 2:20 PM Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced annual continuation inspection visit. LPA met with Judith Muro Office Assistant and she was explained the purpose of today’s visit. LPA reviewed six (6) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings which were all current. LPA also conducted a random audit of residents medication administration records (MAR) which appeared that residents medications are dispensed as prescribed by their physicians. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and this report was discussed and provided to Judith Muro Office Assistant at the conclusion of the visit with appeal rights.the state’s words, verbatim · CDSS document, Jun 18, 2025

Type of visit: Required - 1 Year

On 4/24/2025, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced annual inspection visit. LPA met with Magdalena Romero- Support Staff and she was explained the purpose of today’s visit. The facility is licensed to serve 98 residents of which (42) may be non-ambulatory. There are currently no hospice waiver or bedridden residents at the facility. At 12:35 PM, LPA toured the physical plant inside and outside with Magdalena Romero there were no bodies of water or obstructions on the premises. LPA inspected a total of six(6) bedrooms and six (6) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. During the inspection the bathrooms were in good condition and operational. The water temperature ranged from 105°F to 120.°F, and the bedroom temperatures ranged from 72°F to 78°F. the facility appeared to be clean, sanitary, and appropriately furnished. LPA observed cleaning supplies / toxins stored in the house keeping closet inaccessible to residents. The kitchen was inspected, and there was a 5 day supply of perishable food items and a 7 day of non-perishable food items which was adequately maintained. The fire extinguishers were fully charged and operable. At 1:15 PM, LPA reviewed six (6) resident files for admission agreements, updated physician reports, and needs and services plans which were up to date. Continued on next page. LPA informed Magdalena Romero due to time restraints LPA would have to return to continue the annual inspection. An exit interview was conducted where this report was discussed and provided with Title 22, Regulation 87465 the conclusion of the visit.the state’s words, verbatim · CDSS document, May 8, 2025

Allegation investigated: Staff did not treat resident with dignity and respect. Staff did not ensure resident received prescribed medication.

On 12/16/24, the department conducted an unannounced subsequent complaint visit to the facility listed above. The department met with Office Assistant, Magdalena Romero, and the purpose of today’s visit was explained. During today’s visit, the department interviewed Residents R1-R7, interviewed Staff S2 and S6, and received staff In-Service Training Logs. During a previous visit on 12/13/24, the department toured the facility, interviewed Staff S1, S3-S5, reviewed five (5) resident’s medications, and received documents pertinent to the investigation. The following documents were received and reviewed: Staff Roster, Resident Roster, Resident Physician’s Report, Centrally Stored Medications, Medication Administration Record (MAR), and Admission Agreement. The investigation revealed the following: Unsubstantiated Allegation: Staff did not treat resident with dignity and respect. The complaint allegation alleges that when a resident requested an item the staff tells them “I don’t have time for that." Additionally, it is alleged staff said a resident requested something inappropriate when they didn’t. During the facility tour, the department observed residents Personal Rights posted in the hallway near the office. During record review, the department received and reviewed staff In-Service Training Logs. On 01/03/24, 05/16/24 and 11/18/24 Resident Rights was a subject reviewed and discussed in the in-service. During interviews with Staff S1-S6, were asked if residents are treated with dignity and respect, six (6) out of six (6) stated residents are treated with respect and dignity. Additionally, Staff were asked if they have or have heard staff speaking inappropriately to residents, six (6) out of six (6) stated no they have not nor have they observed it. During interviews with Residents R1-R7, were asked if they are treated with dignity and respect by the staff, six (6) out of seven (7) stated yes, staff treat them with dignity and respect. One resident stated most of the staff treat them with respect and dignity. Additionally, residents R1-R7 were asked if staff have spoken inappropriately to them, four (4) out of seven (7) stated staff have not spoken inappropriately to them. Two residents declined to state, and one stated most of the staff do. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff did not ensure resident received prescribed medication. The complaint allegation alleges that staff delivered a resident’s nighttime medications late. During record review, the department received and reviewed staff In-Service Training Logs. On 02/13/24, 03/13/24, 04/16/24, and 11/18/24 Medication Policies was a subject reviewed and discussed. During the facility visit, the department observed the med tech prepare and dispense medications to the residents. Additionally, the department reviewed Centrally Stored Medications and Medication Administration Record (MAR) for five (5) residents and found five (5) out of five (5) resident’s medications are consistent with properly documented records. During interviews with Staff S1-S6, were asked if residents receive their medications as prescribed, six (6) out of six (6) stated yes, they give medications as prescribed. During interviews with Residents R1-R7, were asked if they receive their medication as prescribed and on time, seven (7) out of seven (7) stated they receive their medications as prescribed and on time. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. During the time of visit the department did not observe or cite any deficiencies. An exit interview was conducted with Office Assistant, Magdalena Romero, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 16, 2024 · control 11-AS-20241206094824

Allegation investigated: Staff does not abide by admission agreement. Staff mismanaging resident’s injections.

Community Care Licensing Division (CCLD) conducted an unannounced visit to Golden Manor Rest Home Facility on 12/11/2024 and was greeted by Administrator Mark Ingber (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: CCLD staff interviewed staff (S1-S3), residents (R1-R7). CCLD staff requested and reviewed copies of the following: VA hospital care notes (dated 04/02/2024), Needs and Service plan (dated 04/04/2024), admission agreement (date 04/04/2024), Medication administration record (MAR) (date July to December 2024). CCLD staff toured the facility with S1. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Staff does not abide by the admission agreement. It is being alleged that staff did not follow the admission agreement for R1. CCLD staff toured the facility and noted residents making a line for medications around 11:30 am. CCLD staff reviewed the admission agreement (date 04/04/2024), page 2 “assistance with taking prescribed and over the counter medications”, VA care plan (date 04/02/2024) page 6 “residential care facilities are required to assist residents with self-administration of medications as needed”, MAR (date July to December 2024), all medications were given to R1 no errors were made. 3 out of 3 staff indicate that all staff follow the admission agreement for R1. 3 out of 3 staff indicate that medications are given to residents 3 to 4 times a day as prescribed by resident’s doctor. R1 indicates that staff do not follow the admission agreement he signed and do not give medication to R1 when needed. 6 out of 7 residents indicate that staff does follow the admission agreements. 6 out of 7 residents indicate that staff serves 3 meals per day and gives medications 3 or 4 times per day. Regarding Allegation #2: Staff mismanaging residents’ injections. It is being alleged that staff did not give R1 injection when prescribed. CCLD staff toured the facility and noted residents lining up for medications around 11:30 am. Reviewed MAR (date July to December 2024). VA notes suggest that injection was new and did not arrive until 08/28/2024. MAR indicates that all medications were given to R1 and R1 signed for self-injection medication from (October to November 2024), needs and service plan (date 04/04/2024), R1 has health issues. S2 indicates that all injections are self-administrated by R1. S2 indicates that R1 moved into facility on 04/04/2024 and that injections started on 08/28/2024. S2 indicates that staff gave R1 all medications that are prescribed and update R1 MAR. R1 signed for injections from October to November 2024. S2 indicates that no staff would inject R1 without a RN or LVN. S2 indicates that from April to September 2024 staff gave medications to R1, then R1 took over medications from September to November 2024 when VA made changes so that facility staff took over in December 2024 giving medications to R1. 3 out of 3 staff indicate that R1 did not have any injections until August 2024. R1 indicates that R1 only received 1 injection for 2024. 6 out of 7 residents indicate that all medications are given to them 3 to 4 times per day. 6 out of 7 residents indicate no injections are given to them as part of their medication list. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff does not abide by admission agreement”, “staff mismanaging residents injections” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Mark Ingber S1.the state’s words, verbatim · CDSS document, Dec 11, 2024 · control 11-AS-20241203170113

Allegation investigated: Staff is mismanaging resident's medications.

On 07/12/2024 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the above-mentioned facility. LPA was met by Mark Ingber (S3), Administrator, and the purpose of the visit was explained. The investigation consisted of the following: On 07/12/2024 LPA requested and reviewed facility documents and toured the facility. LPA interviewed six (6) out of sixty-three (63) residents, four (4) out of twenty-four (24) staff and one (1) witness. The investigation revealed the following: Regarding the allegation: "Staff is mismanaging resident's medications.", it has been alleged that staff at the above-mentioned facility are not managing residents' medication appropriately. Between 09:10AM and 10:30AM, on 07/12/2024, LPA observed business in the Medication Room and interviewed staff one, Christina Revolorio and reviewed documents that were provided. Between 10:30AM and 2:00PM, LPA interviewed three (3) additional staff, one (1) witness, and six (6) residents. Report continues, see LIC9099C. Unsubstantiated Interviews revealed that four (4) out of four (4) staff, six (6) out of six (6) residents and one (1) witness have denied the allegation has taken place. Record reviews have revealed that resident one (R1) has continued to receive all medications as listed on the Medication Administration Record for R1, and that interviews during LPA's visit have validated statements provided to LPA. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. An exit interview was conducted with Magdalena Romero, Assistant Administrator (S2), and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jul 12, 2024 · control 11-AS-20240710083320

Type of visit: Required - 1 Year

On 05/18/24, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced Required- 1 Year visit to Golden Manor Rest Home. Upon arrival at the facility, Licensing Program Analyst (LPA) verified that the facility submitted a mitigation plan report. The facility is licensed to serve 98 residents of which (42) may be non-ambulatory. There are currently no hospice waiver or bedridden residents at the facility. LPA met with Magdalena Romero and we both toured the inside and outside grounds of the facility. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; PPE supplies are readily available to staff, and an additional 30-day supply of PPE is stored on site in a locked cabinet. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is the front patio, courtyard or in the front living room, in addition to the resident’s bedroom. LPA observed required postings throughout the facility. The facility does not support residents with dementia and does not have a memory care unit. A room was inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Furniture in common areas is clean. There are no weapons on the premises. Resident bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew. The water temperature measured at 108.3f degrees Fahrenheit in residents’ room and within regulation in the common area. A comfortable temperature was maintained in the facility. LPA toured the kitchen area and observed a two day supply of perishable and a seven (7)-day supply of non-perishable food. Knives and toxins were kept locked and separate. Centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to resident in care. The First Aid kit was available and inaccessible to residents. Several fire extinguishers were observed throughout the facility. Outside grounds were toured, and no bodies of water were observed. Walkways around the facility were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was provided to staff Magdalena Romero.the state’s words, verbatim · CDSS document, May 18, 2024

Allegation investigated: Staff did not safeguard resident's personal items

On 10/23/2023 at 11:18 am Licensing Program Analyst (LPA) David España conducted unannounced initial 10-day visit to the facility and purpose of a complaint investigation of the allegations listed above were explained. Licensing Program Analyst (LPA) David España met Magdalena Romero, Day Manager and Administrator, Mark Ingber. Upon arrival at the facility, LPA España conducted a risk assessment at the facility entrance. Based on the assessment, the facility is clear of Covid-19 infection. Today’s complaint visit was conducted with Magdalena Romero, Day Manager and Administrator, Mark Ingber. The investigation consisted of following: Interviews and Record reviews. On 10/23/23, LPA obtained a copy of the current resident’s roster, staff roster, resident #1-#4 records. LPA España, toured the physical plant with Day Manager, interviewed R#1-R#4. (Evaluation Report continues LIC-0099-C) Unsubstantiated On 10/23/23, LPA obtained Resident and Staff rosters, R#1-R#4 file (ID/emergency information, Admission agreement, Physician's report, Needs and Services Plan, Mars). LPA obtained R#4 admission and discharge dates. LPA reviewed R#1-R#4 Preplacement appraisal information, Resident appraisal, Resident personal property and valuables files (June, July, August, September). LPA requested and received the following documents and files for R#1-#4: Resident Roster, Staff Schedule R#1-5 (Face sheet, Physician's Report, Admissions agreement, Pre-Appraisal, Needs and Services Plan.) Documents were received at the time of visit. On 10/23/23 from 11:18 am – 2:50 pm the Department interviewed (4) out of (66) residents (R#1-R#4) and (4) out of (66) reported no issues with personal items missing. On 10/23/23 from 11:18 am – 2:30 pm the Department interviewed (5) out of (21) staff (S#1-S#5) and (5) out of (21) reported no issues with personal items missing. Regarding Allegations: “Staff did not safeguard resident's personal items.” The investigation revealed the following: Regarding the allegation “Staff did not safeguard resident's personal items.” 4 out of 4 resident interviewed disagreed with the allegation and denied having any issues with safeguarding of their personal items. 5 out of 5 staff (S#1-S#5) denied the allegation, S#1-S#5 denied not providing safeguard resident's personal items. Interviews conducted with S#1-S#5, stated that the staff if asked to safeguard residents’ personal items they are to sign documentation to safeguard resident’s personal items. Interviews conducted with R#1-R#4 stated they have never had problems with staff and notices concerning personal items. In (R4)'s records show that, from 01/25/2007 to 07/11/2022, (R1) transitioned to the hospital from Golden Manor Rest Home. As a result of transition, (R1’s) medications did remain consistent per S#1. According to Medication Administration Records for (R#4), medications were taken daily, and no medications were missed or refused between 01/25/2007 to 07/11/2022. There were no non-prescribed medications issued by Golden Manor Rest Home per record review. Per record review #R4 has Scheophrenia Paranoid Disorganized per UCLA Family Health Center, 1920 Colorado Ave., Santa Monica, CA 90404. Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are unsubstantiated. An exit interview was conducted, and a copy of the report was given to Administrator, Mark Ingber.the state’s words, verbatim · CDSS document, Oct 23, 2023 · control 11-AS-20231017151357