Golden Oak Residential Care

Allegation investigated: Staff did not provide adequate nutrition to resident, resulting in resident’s death Resident developed a pressure injury due to staff neglect Staff left resident in urine soaked bedding for extended periods of time Staff did not provide resident with adequate fluids Resident sustained an injury due to staff not providing a safe sleep environment

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver findings of the above allegations. LPA met with Cristina Uy, House Manager and informed them of the visit. The Department’s investigation involved interviews with staff and residents and review of records. On 09-07-2022, Community Care Licensing (The Department) received a complaint report with the following allegations. It was alleged that staff did not provide adequate nutrition to resident, resulting in resident’s death. Information received indicated that Resident #1 (R1) was not provided with enough food, resulting in loss of weight. LPA’s records review revealed that R1 had resided for only 10 days in June 2022 in the facility. R1 had been under hospice care until R1 passed away in July 2022. LPA’s attempts to contact R1’s relevant party and hospice agency were unsuccessful due to their non-responsiveness. Continued on LIC9099-C... Unsubstantiated LPA conducted an interview with Staff #1 (S1) who stated that all residents have been provided with three (3) meals a day and plenty of snacks. S1 stated that R1’s records were not available due to expiration of record retention periods. LPA conducted interviews with three (3) residents, all of whom stated that they have had no issues with food services. The Department’s investigation did not provide enough information to corroborate the allegation that staff did not provide adequate nutrition to resident, resulting in resident’s death. This allegation is unsubstantiated. It was alleged that resident developed a pressure injury due to staff neglect. Information received indicated that R1’s pressure injury became so much worse that wound care personnel advised that there was nothing they could do. LPA’s records review revealed that R1 had pressure injury already before R1 was admitted to the facility. LPA conducted an interview with S1 who stated that all residents receive one (1) to two (2) hour check. S1 stated that R1 arrived at the facility with a bruise on their elbow, but R1 did not have pressure injuries. LPA’s attempts to contact R1’s relevant party and hospice agency were unsuccessful due to their non-responsiveness. The Department’s investigation did not provide enough information to corroborate the allegation that resident developed a pressure injury due to staff neglect. Based on records review and interviews conducted, this allegation is unsubstantiated. It was alleged that staff left resident in urine soaked bedding for extended periods of time. LPA’s attempt to contact R1’s relevant party was unsuccessful due to their non-responsiveness. LPA conducted an interview with S1 who stated that all residents receive one (1) to two (2) hour check. The Department’s investigation did not provide enough information to corroborate the allegation that staff left resident in urine soaked bedding for extended periods of time. This allegation is unsubstantiated. It was alleged that staff did not provide resident with adequate fluids. Information received indicated that R1’s hospice nurse informed R1’s relevant party that R1 was severely dehydrated after leaving the facility. LPA’s attempts to contact R1’s relevant party and hospice agency were unsuccessful due to their non-responsiveness. LPA conducted an interview with S1 who stated that all residents have been provided with water and drinks throughout the day. LPA conducted interviews with three (3) residents, all of whom stated that they have had no issues with the facility services. The Department’s investigation did not provide enough information to corroborate the allegation that staff did not provide resident with adequate fluids. This allegation is unsubstantiated. Continued on LIC9099-C.... It was alleged that resident sustained an injury due to staff not providing a safe sleep environment. Information received indicated that R1 sustained head wound from bed rails. LPA’s attempt to contact R1’s relevant party was unsuccessful due to their non-responsiveness. LPA conducted an interview with S1 who stated that staff have provided pillows to residents who use bed rails to avoid any injuries. LPA conducted interviews with three (3) residents, all of whom denied having any injuries from bed rails. The Department’s investigation did not provide enough information to corroborate the allegation that resident sustained an injury due to staff not providing a safe sleep environment. This allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 20, 2026 · control 18-AS-20220907152658

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that five (5) residents live at this facility. There was two (2) staff members present. The House Manager, Cristina Uy was advised of the annual and came to conduct and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Five (5) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Three (3) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Abigail Ventura, Administrator’s certificate expiration date was 12/18/2025. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the laundry room. There is a locked location for storing laundry soap, cleaning supplies and chemicals in the closet in the laundry room. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is one (1) secured fireplace at this facility. There are zero (0) pools at the facility. There is one (1) secured gate that has a self-latching lock located on the northeast side of the house. LPA observed emergency supplies and one (1) first aid kit. The last emergency fire drill was conducted on 11/05/2024. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed that they were dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed six (6) smoke detectors and one (1) carbon monoxide detectors throughout the facility. There were two (2) fire extinguishers on site, date charged was 02/06/2024. Pursuant to Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to House Manager, Cristina Uy.the state’s words, verbatim · CDSS document, Dec 2, 2024

Type of visit: Required - 1 Year

On 12/5/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by Caregiver, Cristina Uy who was informed of the purpose of the visit. At the time of visit there was 2 staff and 5 residents present. LPA was informed that the other resident went out with family. LPA toured the facility inside and out with Cristina Uy. Tour included: Kitchen: LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the census. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen cabinet under the sink, available only to authorized individuals. Trash cans has tight-fitting lid. Dishwasher is used to clean and sanitize dishes. Fridge, freezer, and all need appliances were present and shown to be in working condition and clean. Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 72 degrees Fahrenheit. Hallway: LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items. Medication: Medications were labeled and stored in separate bins inside of a locked kitchen cabinet and are distributed according to physician orders. The first aid kit was complete. Continue on LIC809-C Continued from LIC809. Bathroom: LPA toured hall bathroom and observed bathroom to be clean and equipped with grab bar and non-skid mat. There is also a good number of personal toiletries available for the residents in care. The hot water measured at 135 degrees Fahrenheit which is above regulatory standard (citation will be issued). Bedroom: LPA toured four #4 out of #4 resident bedrooms and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs, and lighting. Night lights were maintained throughout the facility. Resident #4 bedroom has a private bathroom. LPA observed bathroom to be clean and hot water was measured at 135 degrees Fahrenheit. Garage: LPA tour the garage and observed garage to be clean and not cluttered. Laundry: Washing machine and dryer are all in good repair and sufficient for census. Cleaning supplies are stored away in the laundry room, inaccessible to clients. Backyard: LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gate remain unlocked. No bodies of water were observed. Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Fridge and freezer are large enough to accommodate required perishable foods. Records: All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Two #2 staff and three #3 residents' records were reviewed. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 12/18/2023. Interview: two #2 staff and five #5 residents were interviewed. Therefore, based on the observations made during today’s visit, one #1 deficiency will be cited per Title 22, Division 6 of the California Code of Regulations. See LIC809-D. An exit interview was conducted, and this reported was provided along with appeal rights to Cristina Uy.the state’s words, verbatim · CDSS document, Dec 5, 2023