Golden Pond Retirement Community

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Required - 1 Year

Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 1/28/25. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator/ Executive Director (ED). LPA met with ED, Ryan Nakao, (certificate # 6066510740 expires on 03/01/25) and a brief interview followed. The tour began in the kitchen. LPA inspected pantry area and pulled sample of a dozen dry goods to ensure that all were dated and stored properly. LPA then inspected the walk-in refrigerator and freezer. All food items were dated and packaged properly at the time of this inspection. The hood over the primary stove was last inspected on 11/07/24 by Niagara Hood Cleaning and it was in compliance at the time of this inspection. LPA also observed that fire extinguishers were last inspected on 8/30/2024 by Foothill Fire Ins. and were also in compliance. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA, escorted by the Marketing Director, entered a resident’s room in memory care, as the door had been left open. LPA pulled the emergency cord in the bathroom to test response time. After 20 minutes, the LPA and the Marketing Director left the room to alert the Memory Care Director to the fact that they had gotten no response. LPA located the Memory Care Director (MCD) along with 2 care staff assisting 8 of the 12 residents in memory care with lunch. LPA informed the MCD and the ED about the lack of response to the alert activated. LPA inspected 2 resident rooms memory care. Each had the required furniture, furnishings, and lighting to be in compliance. Bathrooms had grab papers, towels, and non-skid surfaces in the showers. Hand soap was locked and inaccessible to residents in care. LPA provided technical assistance regarding non-toxic soap being available for residents to use after using the restroom. Locked cabinets were present in each of the memory care bathrooms to store personal care items that required supervision for resident use. LPA began a file resident file review, but due to time constraints, Community Care Licensing will return at a later date to complete this annual inspection. According to the California Code of Regulations, Title 22, no deficiencies were cited during today's visit. A copy of this report was provided and an exit interview conducted.the state’s words, verbatim · CDSS document, Jan 28, 2025

Type of visit: Case Management - Deficiencies

On 12/6/24, at 3:20pm Licensing Program Analysts (LPAs) Kevin Gould and Holly Williams conducted an unannounced case management deficiencies inspection to deliver a civil penalty. LPA met with Director of Care, Misty Wilson, and together discussed the Department’s findings. On June 29, 2023, the department concluded the complaint investigation regarding the following allegations: Questionable Death The above allegation was substantiated, and the licensee was cited for the following violation of the California Code of Regulations (CCR) Title 22, 87705 (f)(2) Care of Persons with Dementia: The following shall be stored inaccessible to residents with dementia: Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. The department has determined the deceased resident had an extensive history as having a preferred activity of smoking. Per family, resident being allowed to continue their preferred activity of smoking was a condition of living at the facility. For several years, the facility allowed the resident to smoke on their balcony unsupervised. Throughout the duration of the residents stay at the facility, the resident was allowed to retain and possess their own cigarettes and lighters and was permitted by the facility to smoke without supervision. The facility continued to provide supervision and care for the resident but not during their preferred activity of smoking. Resident records reviewed by the Department indicate the resident did have a diagnosis of dementia per Physician's Report dated April 26, 2021. Report Continued on LIC 9099-C. Per Title 22 Regulations, for residents with a diagnosis of dementia, items such as matches or cigarettes shall be stored inaccessible to residents in care. Per previous interviews conducted by the Department, the former resident’s cigarettes were not stored inaccessible to the resident which resulted in the reported incident on December 27, 2022, and the resident's subsequent death as a result of the injuries sustained. The Department concluded an analysis and determined that a civil penalty is warranted for the death of a resident as a result of a violation of Title 22 Regulations. Per Welfare and Institutions Code section 1569.49(e): for a violation that the department determines resulted in the death of a resident, the civil penalty shall be fifteen thousand dollars ($15,000). Today, December, 6, 2024, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49 for a violation that the Department has determined resulted in the death of a resident in the amount of $15,000. Exit interview conducted. A copy of the report issued. Appeal rights provided. Director of Care, Misty Wilson's signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Dec 6, 2024

Type of visit: Case Management - Deficiencies

On 12/6/24, at 3:20pm Licensing Program Analysts (LPAs) Kevin Gould and Holly Williams conducted an unannounced case management deficiencies inspection to deliver a civil penalty. LPA met with Director of Care, Misty Wilson, and together discussed the Department’s findings. On October 10, 2022, at 8:58 p.m., a resident (R1) pressed the call button to receive help to the restroom. Facility staff failed to respond to R1's call for help in a timely manner, causing R1 to get up on their own. R1 got up, fell, hitting their head on an unknown object. R1 laid on the ground for approximately 35 minutes before staff checked on them. Once staff found R1, they immediately called 911 and AlphaOne was dispatched at 10:49 p.m. R1 was transported to the hospital and diagnosed with a hip fracture. Staff openly admitted to failing to check on R1 in a timely manner, resulting in R1 falling, which caused R1 to break their right hip. The allegation of Neglect/Lack of Supervision for failure to seek timely medical attention is substantiated as staff failed to provide aid, which resulted in R1 laying on the ground for a prolonged amount of time. Per R1's care plan, R1 needs assistance with dressing, bathing, and toileting. R1 is a one-person assist. R1 needs escort service to the toilet. R1 called for help. Per records provided to the department, the facility staff did not respond to the call pendant pressed at 8:48 p.m. until 10:22 p.m. which resulted in the resident falling and sustaining an injury. Report Continued on LIC 9099-C At the time the complaint was concluded, an immediate civil penalty was issued for the amount of five hundred dollars ($500) per California Health and Safety Code section 1569.49(c)(1), due to the violations above resulting in resident injury. The Department concluded an analysis and determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code section 15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death or protracted loss or impairment of function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including, but not limited to, hospitalization, surgery, or physical rehabilitation.” Today, December 6, 2024, the Department will be issuing a civil penalty per Health and Safety Code section 1569.49(f) for a violation that the Department constitutes as serious bodily injury in the amount of ten thousand dollars ($10,000). However, since an immediate civil penalty of five hundred dollars ($500) was previously issued on March 22, 2023, the amount of the civil penalty issued today will be nine thousand five hundred dollars ($9,500). Exit interview conducted. A copy of the report issued. Appeal rights provided. Director of Care, Misty Wilson's signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Dec 6, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit. LPA Moleski met with Care Services Director Misty Wilson and explained the purpose of the visit. This visit is to confirm immediate exclusion orders for a staff member (S1). Wilson said that S1 is no longer employed at this facility, effective 8/12/24, due to excessive call offs. Wilson acknowledged that this is an immediate exclusion for S1 effective 09/13/2024, which means that S1 cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility. Wilson agreed to have S1 removed from the facility's Guardian roster as soon as possible. No deficiencies were cited during this visit. An exit interview was held with Wilson. A copy of this report and the immediate exclusion notice were left with Wilson. A signature on this report acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Sep 13, 2024

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Case Management - Other

On 05/31/24, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct a case management visit. The LPA identified herself upon arrival, stated the purpose of the visit and asked to speak with the Designated Facility Administrator (DFA). LPA met with Amanda Friedman and interviewed her briefly. DFA contacted Community Care Licensing to alert the office that she would be leaving Golden Pond and that 5/31/24 would be her last day. This case management is regarding the transition that will occur in her absence. DFA shared that her departure was planned and the Licensee had been advertising for a replacement. During the interim, the Care Director, Misty Wilson, who also had her Administrator's Certificate, would act as the Designated Facility Administrator until a new one could be hired. The DFA stated that based on her conversation with the Licensee, the facility would not have a gap in coverage. The LPA obtained an updated LIC 308, LIC 500, and resident roster. According to California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. Exit interview.the state’s words, verbatim · CDSS document, May 31, 2024

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Amanda Friedman and explained the purpose of the visit. LPA Moleski reviewed 10 resident files (R1-R10) and 10 staff files (S1-S10). R9's latest LIC 602 was dated June 17, 2022. R9 has dementia, according to the LIC 602. Friedman said R9 does not have a more recent LIC 602. LPA Moleski toured the facility with Friedman and inspected common areas, the kitchen, bedrooms, bathrooms, and outdoor areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 72 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 115 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. LPA Moleski observed first aid supplies, fully-charged and up-to-date fire extinguishers, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locking room for the storage of medication. LPA Moleski observed locked closets for the storage of cleaning solutions. LPA Moleski interviewed five staff members (S8, S10, S11-S13) and five residents (R5, R11-R14). This facility is being cited per 22 CCR Section 87705(c)(5). An exit interview was held with Friedman. Appeal rights and a copy of this report were left with Friedman.the state’s words, verbatim · CDSS document, Jan 22, 2024

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Case Management - Legal/Non-compliance

On 10/17/23 at 2:00pm, Department representatives Kevin Gould (LPA), Kim Viarella (LPA), Czarrina Camilon-Lee (LPM), Stephen Richardson (LPM) and Stephenie Doub (RM) met with representatives from Golden Pond Retirement Community to discuss recent compliance issues at the facility and the steps the facility is taking to address the department's concerns. Representing Golden Pond is Brian Walgenbach (Licensee), Amanda Friedman (Administrator) and Attorney Joel Goldman. The department addressed the concerns regarding the death of a resident and the facilities efforts to be in compliance with dementia care regulations. The facility has updated the facility smoking policy and evaluated all resident's with dementia to ensure no prohibited items are accessible to residents. Additional training and consultations with outside organizations. The department also addressed concerns regarding staff responses to signal system which resulted in resident injury. The facility has stated they have conducted training for staff in regards to responding to signal systems, auditing response times and continued consulting with outside organizations. The department and facility representatives discussed recent compliance issues with resident record keeping to ensure staff member shall have access to all up to date resident records to appropriately respond in case of emergency. Facility will continue ongoing training addressing resident documentation. facility continues to contract with a consulting group providing a nurse to audit med room systems. The department also discussed previous citations for annual assessments for dementia residents. Medication administration and following physician instructions. Elopement of Resident with dementia in memory care unit. The facility provided the department with updates and policies the facility has made to address the above issues including continued consultation with outside organizations and additional staff training. Report Continued on LIC 9009-C. In summary the facility agreed to the following and will provide the department of documentation of policy and procedure changes. Facility will identify residents with Dementia and ensure prohibited items described in regulations are made inaccessible and the procedure in which to store these items. Included in the POC is the current Resident Smoking Policy, The Policy/Procedures regarding smoking and the documented staff training. Staff training and knowledge of centrally stored resident records to ensure all staff members have access to updated resident documents. Continue ongoing training addressing resident documentation. facility continues to contract with a consulting group providing a nurse to audit med room systems. Call light response is monitored and reviewed by the Director of Care and appropriate action is taken if staff do not respond in an appropriate amount of time. Elopement risk is evaluated with our residents. Residents are monitored and checked if not in the line of vision of the staff. Facility will continue to evaluate suitable outdoor furniture for memory care space to meet the needs or residents. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's meeting. An exit interview was conducted, and a copy of this report was mailed to the facility for signature.the state’s words, verbatim · CDSS document, Oct 17, 2023

Type of visit: POC

On 10/3/23 at 1:45pm, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced Plan of Correction (POC) inspection to ensure all components of the plan of correction have been completed. LPA observed written plan of correction and documentation of in-service training for all staff members. The POC has been completed and cleared. POC clearance letter generated and provided to the facility. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 3, 2023

We haven’t transcribed this report yet. The complete document is on the state’s site.