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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881679
Report Date: 04/22/2026
Date Signed: 04/23/2026 08:21:27 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2026 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20260415114354
FACILITY NAME:GOLDEN TURTLE ASSISTED LIVINGFACILITY NUMBER:
331881679
ADMINISTRATOR:DAVIS, KOREYFACILITY TYPE:
740
ADDRESS:8285 TRISTAN LANETELEPHONE:
(626) 324-0898
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:6CENSUS: 0DATE:
04/22/2026
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:N/ATIME COMPLETED:
09:00 AM
ALLEGATION(S):
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Uncleared adult in home
INVESTIGATION FINDINGS:
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On 4/22/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit for the purpose of launching the complaint investigation into the allegation listed above. The investigation is summarized as follows:

Information received alleged an individual was residing in the home without proper clearance. Upon LPA Flores’ arrival at the facility, LPA approached the entryway of the home where the door was wide open. An unknown individual was near the entryway and LPA introduced herself. LPA Flores explained the purpose of the visit and was informed by the individual that the home was not a licensed facility. The individual reported that they did not wish to disclose additional information, and LPA concluded the attempt to interview the unknown individual. LPA Flores contacted the listed Administrator via telephone.

(Continue to LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 18-AS-20260415114354
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GOLDEN TURTLE ASSISTED LIVING
FACILITY NUMBER: 331881679
VISIT DATE: 04/22/2026
NARRATIVE
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(Continuation from LIC9099C)

An interview conducted with the Administrator reported that the facility was currently awaiting Medi-Cal authorization to begin accepting residents. At this time, there are no resident in care. The Administrator reported that the facility is currently being rented out to the unknown individual as a form of financial supplement as the facility awaits for resident placement. The Administrator reported that the individual residing in the facility will not be future staff or have any association to the facility.
Therefore, the allegation of “uncleared adult in home” is deemed substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations Title 22 is being cited on the attached LIC9099D.

An exit interview was conducted, and a copy of the LIC9099, LIC9099C, LIC9099D, and appeal rights were reviewed and provided to Administrator.

A signature was not obtained as there were no staff or Administrator on-site during the time of visit.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20260415114354
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GOLDEN TURTLE ASSISTED LIVING
FACILITY NUMBER: 331881679
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2026
Section Cited
CCR
87208(a)
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...The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with
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An informal meeting will be held with the Licensing Department. At this time, a written statement shall be provided to the department with the intent of license and will be submitted to be LPA by close of business on 4/29/2026 via email.
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the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement was not met with evidence by: The facility is being leased out to an individual as a private residence.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3