Caring Hearts Elder Care

Type of visit: Case Management - Annual Continuation

Unannounced Case Management Visit-Annual Continuance visit made out to this facility on 07/24/2026 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Kulich who were met by the facility staff person, Sarabgit Kaur, who was briefly interviewed at this time. LPAs requested that this staff person go ahead and contact the facility designated Administrator to inform her that CCL was present at this time. Current census was 6 residents. This LPA wrapped up this follow up visit and concluded the annual visit from 07/10/2026 without the presence of the facility designated Administrator, Golalai Matin, being present at this time. All forms and documents were left with the facility staff person, Sarabjit Kaur, at this time. The purpose of this visit was to follow up and complete the annual visit that was last conducted on 07/10/2026. Due to technical difficulties with this LPA's laptop, the previous annual was unable to be completed at that time. All forms and documents related to that visit from 07/10/2026 were printed and a version was given to the facility staff person at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 24, 2026

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 07/10/2026 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Kulich who was met by the facility designated Administrator Golalai Matin who was briefly interviewed at this time. Current census was 6 residents. It was learned that there weren't any residents under the care of hospice at this time. It was learned that this facility does have an approved hospice waiver to be able to accept and retain up to 2 hospice residents at any given time. It was learned that there were (3) residents deemed to have the diagnosis of dementia at this time. It was learned that this facility does have a dementia program on file at this time. It was learned that there was (1) resident receiving services through home health at this time. It was learned that there weren't any residents deemed to be bedridden at this time. This facility does have an approved bedridden fire clearance to be able to accept and retain up to (1) resident to occupy designated bedroom #1. There were (2) other facility staff members, S1 and S2, present during this annual visit. Tour of the facility was conducted. A tour of the living area, dining area, and all other areas intended for resident use was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. Cabinets and drawers were reviewed at this time. Drawers storing knives and sharps were reviewed to make sure that they were locked and made inaccessible to the residents at all times. Cabinets storing detergent and all cleaning supplies were reviewed to make sure that they were locked and made inaccessible to the residents at all times. Facility restrooms were toured. Grab bars and non skid mats were observed to be present and in good working order at this time. Hot water temperatures were taken to make sure that the hot water being dispensed was within the allowed range of 105-120 degrees at all times. A review of the facility medications for the residents was conducted. It was learned that all of the resident medications were centrally stored. First aid kit, located in the facility medication locker located in the office area, was reviewed. It was observed that it did contain all of the required components and was in compliance at this time. A review of the facility food supply was conducted. A tour of the facility pantry was conducted to make sure that there was a sufficient supply of 2-day perishables and 7-day non perishable food quantities on hand at all times. It was learned that there was an additional refrigerator being used in the garage area. Tour of the garage area was conducted. It was observed that this space was being used to store household items and personal items for the residents in care at this time. Laundry area was toured. It was observed that the door leading into the laundry area did not have the ability to be locked at this time. It was observed that the cabinets within the laundry area were equipped with a locking mechanism to be able to store detergents and bleach so that they were inaccessible to the residents at all times. A tour of the facility resident bedrooms was conducted. Furniture and furnishings were observed to be present and able to meet the needs of the residents at this time. Linen closet, located in the facility hallway, was reviewed. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, (2) side gates, and all other exits was conducted. A review of (6) facility resident files was conducted and noted on the following LIC 858. A review of (2) facility staff files was conducted and noted on the following LIC 859. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. The following civil penalties were assessed in the amount of $1000 on the following LIC 421. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 10, 2026

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 07/10/2026 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Kulich who was met by the facility designated Administrator Golalai Matin who was briefly interviewed at this time. Current census was 6 residents. It was learned that there weren't any residents under the care of hospice at this time. It was learned that this facility does have an approved hospice waiver to be able to accept and retain up to 2 hospice residents at any given time. It was learned that there were (3) residents deemed to have the diagnosis of dementia at this time. It was learned that this facility does have a dementia program on file at this time. It was learned that there was (1) resident receiving services through home health at this time. It was learned that there weren't any residents deemed to be bedridden at this time. This facility does have an approved bedridden fire clearance to be able to accept and retain up to (1) resident to occupy designated bedroom #1. There were (2) other facility staff members, S1 and S2, present during this Post Licensing visit. Tour of the facility was conducted. This Post Licensing visit was conducted in conjunction with Annual visit as well. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 10, 2026

Type of visit: Prelicensing

On 06/30/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to this facility to conduct an annual visit. LPA met with applicant, Golalai Matin and explained the purpose of the visit. The purpose of this visit was to conduct a Pre-Licensing Visit. This facility will hold 6 residents, of which 3 may be non-ambulatory and 1 may be bedridden. This facility also has a dementia plan on file with a hospice waiver for 2 residents. Current census was 0. A brief interview with applicant Matin was conducted. The perspective facility administrator has an active administrator certificate #7030250740 and expires on 10/06/2025. A tour of the facility was conducted. A tour of the kitchen was conducted. LPA observed a sufficient amount of 2-day perishable and 7 day non-perishable food supply. LPA observed knives and toxins locked and made inaccessible to residents in care. A medication cabinet was identified in the cabinet in the kitchen. A fire extinguisher was also located in the kitchen and was purchased on 04/17/2025 with a receipt attached to it. A tour of the back yard was conducted with no hazards present. Perimeter fence and exit gates were observed to be in good repair. A tour of the living area, dining area, and other areas intended for resident use was conducted. Furniture was observed to be in good repair and meet resident needs. A tour of 2 bathrooms were conducted. Hot water was taken to ensure compliance within regulation. Grab bars were present and in good repair. A tour a 4 resident bedrooms were conducted. Resident furniture was observed to be in good repair and meet residents needs. Rooms #1 and #2 are able to house non-ambulatory residents. Bedroom #1 may be one bedridden resident. Bedroom #3 and #4 may only house ambulatory residents. A tour of the laundry room was conducted. Toxins and other cleaning supplies were identified and made inaccessible to residents in care. A linen closet was identified and presented a sufficient amount of linens to meet the needs of the residents. Emergency lighting was present throughout the home. Carbon monoxide and smoke alarms were observed and tested to ensure it was in proper working condition. Based on the observations made during this visit, this applicant has passed the pre-licensing inspection. Component III was reviewed with this applicant. An exit interview was conducted and a copy of this report was provided to the applicant at the end of this visit.the state’s words, verbatim · CDSS document, Jun 30, 2025

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Golalai Matin, Applicant/Administrator Interview Method: Virtual interview (Microsoft Teams) On June 20, 2025, Applicant/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility Operation: License Type, Client/Resident Populations, and Program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readinessthe state’s words, verbatim · CDSS document, Jun 20, 2025