Golden Hearts Elderly Care 2

Allegation investigated: Staff overmedicated a resident while in care Staff interfered with a resident's telephone call Staff did not ensure a resident consumed an appropriate amount of liquids while in care Staff did not meet a resident's hygiene needs Staff mishandled a resident's pacemaker monitor Staff retaliated against resident while in care

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. The Department received a complaint on 01/10/2025 and LPA Mendivil conducted the initial 10-day visit on 01/16/2025. During the initial visit LPA Mendivil obtained copies of physician report, medication administration records and resident appraisal for Resident 1 (R1). Regarding the allegations staff overmedicated a resident while in care, staff interfered with a resident’s telephone call, staff did not ensure a resident consumed an appropriate amount of liquids while in care, staff did not meet resident hygiene needs, staff mishandled a resident’s pacemaker monitor and staff retaliated against resident while in care, the investigation revealed the following: Unsubstantiated Resident 1 (R1) moved into the facility in November 2024 with a diagnosis of senile degeneration of the brain. It was alleged R1 was over medicated on or around January 06, 2025 when a medicated topical cream was over applied. Per interviews with 2 out of 2 staff indicated they do not over medicate residents and they follow all physician’s orders. Per interview with hospice nurse there were no concerns about R1 being over medicated. Per review of medication administration records R1’s medication appear to be given as prescribed. It was alleged that staff interfered with a resident’s telephone call. Per interviews with 2 out of 2 staff indicated that they have never interfered with resident’s telephone calls. 5 out of 5 residents interviewed stated their calls are not interfered with or interrupted. It was alleged that staff did not ensure a resident consumed an appropriate amount of liquids in care. Per interviews with 2 out of 2 staff stated residents are provided water and liquids throughout the day and are encouraged to drink water. 5 out of 5 residents interviewed stated they have a water cup with them daily. LPA Mendivil observed all residents to have their own water cup near and the cups were full. Per interview with R1’s hospice nurse indicated there was no issues with R1’s hydration. It was alleged that staff did not meet resident hygiene needs. Per interview with R1’s hospice nurse it was reported that hospice’s bath aid would come 3-4 times per week. Interview with hospice nurse reported that R1 appeared to be clean. Interviews with 2 out of 2 staff stated if R1 needed more assistance with hygiene they would provide assistance. Based on interviews with 5 out of 5 residents stated they are assisted with hygiene needs. It was alleged that staff mishandled a resident’s pacemaker monitor. Per review if R1’s LIC 602 Physician’s Report dated November 20, 2024 did not mention a use of a pacemaker. No photographs, medical records or documentation could be found to verify the presence of a pacemaker for R1. Administrator Nargis Elahi stated no one told her about R1 having a pacemaker, but had they she would not unplug the monitor. It was alleged staff retaliated against resident. Per interviews with 2 out of 2 staff stated they did not retaliate against any resident. Staff stated they have not acted negatively or rude to any resident. Interviews with 5 out of 5 residents stated the staff is kind and respectful. Therefore based on the preponderance of evidence through records reviewed and interviews the allegations staff over medicated a resident while in care, staff interfered with a resident’s telephone call, staff did not ensure a resident consumed an appropriate amount of liquids while in care, staff did not meet resident hygiene needs, staff mishandled a resident’s pacemaker monitor and staff retaliated against resident while in care are determined to be UNSUBSTANTIATED meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiencies are being cited in today's visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 20, 2026 · control 22-AS-20250110122555

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced required visit to the facility for the purpose of conducting the required annual inspection. LPA Rodriguez explained reason for visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted facility administrator (AD) Nargis Elahi about visit. AD Elahi designated for staff on duty (S1) Jackelin Mijares to receive and sign report due to AD Elahi being unavailable. The PUB475 "See Something, Say Something" poster was observed to be located at the entrance of the facility. LPA observed the Administrator's Certificate for Nargis Elahi, which expires on 11/11/2026. LPA toured the interior and exterior portions of the facility with S1. The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 1 may be bedridden in room #1 and 6 may be on hospice. For this visit, there are a total of 5 residents in care, of which 0 are on hospice and 0 are bedridden. There are a total of 7 bedrooms, of which 6 are private resident rooms, and 1 bedroom for staff. LPA toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 2 restrooms, of which were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature was measured to be at 108.8 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen and the hallway. Fire extinguishers were dated and tagged for the date of 2025. LPA observed the emergency disaster and evacuation plan, which is posted at the entrance of the facility. Facility had back-up emergency food and water supply, located in the garage. LPA observed that First Aid Kit had all the required components. Medications and toxins were also observed to be locked and inaccessible to residents in care. For the exterior portion, LPA observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which were self-closing and self-latching. No bodies of water were observed. For today's visit deficiencies and a civil penalty was issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with S1 Mijares and AD Elahi via phone call. A copy of this report and appeal rights were explained and provided at the end of visit.the state’s words, verbatim · CDSS document, Sep 15, 2025

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced case management visit in conjuction with ongoing complaint investigation for complaint control # 22-AS-20250110122555 . LPA was greeted and granted entry into the facility by Noor Elahi, Caregiver and explained the reason for the visit. Administrator/Licensee Nargis Elahi arrived shortly after. Per review of LIC 500 Personnel Report received on 02/03/2025 the facility personnel record indicated that that Staff 1 started working at the facility on 10/2/2024. Per review of both Guardian and internal system for CCLD indicate S1 is not associated with Golden Hearts Elderly Care 2. S1 was advised to leave the facility and Staff 3 (S3) and Administrator took over care of the residents. Per review Staff 2 (S2) on LIC 500 started on 01/23/2025 and based on Administrator S2 worked a minimum of 5 days in January 2025. S2 was not associated to Golden Hearts Elderly Care 2. Based on observations made during today's visit deficiencies are being cited. An immediate civil penalty is assessed. An exit interview was conducted and a copy of this report was provided along with appeal rights.the state’s words, verbatim · CDSS document, Feb 7, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Feb 8, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement was not met evidence by S1 and S2 were not associated to the facility. This poses an immediate health and safety threat to persons in care.the state’s words, verbatim · CDSS document, Feb 7, 2025

Plan of correction: Licensee/Administrator agreed to associate both S1 and S2 to the correct facility and provide proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit in conjuction with complaint control number 22-AS-20250110122555. During the visit, LPA Mendivil discussed reporting requirements as on the visit on 12/30/2024 LPA Mendivil observed Resident 1 (R1) on the floor of the living room. Administrator//Licensee Nargis Elahi stated she did not report the fall that occurred on 12/30/2024 because it did not result in injury of the resident. LPA Mendivil reviewed reporting requirements with Administrator/Licensee Nargis. LPA Mendivil requested document of LIC 602 Physician's Report for R1, Administrator/Licensee Nargis stated did not have a copy of LIC 602 at present time. LPA Mendivil reviewed resident records regulation with Administrator/Licensee. Based on observations made during today's visit deficiencies are being cited. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 16, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(1)(D) · Plan of correction due date: Jan 29, 2025

(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... (D) Any incident which threatens the welfare, safety or health of any resident.. This requirement was not met as evidence by Administrator not reporting a fall that occurred on 12/30/2024. This poses a potential health and safety risks to persons in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Licensee/Administrator agreed to submit LIC 624 for incident that occured on 12/30/2024. LIcensee agreed to review reporting requirement regulation and provide proof of understanding.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(d) · Plan of correction due date: Jan 22, 2025

(d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. : This requirement was not met as evidence by facility was unable to provide LPA Mendivil with requested documents for Resident 1 (R1). This poses a potential health & safety risk to person in care,the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Licensee/Administrator agreed to email LPA LIC 602 by POC due date

Allegation investigated: Licensee did not follow proper eviction procedure

On this day Licensing Program Analyst (LPA) Andrea Mendivil made unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry by Caregiver Noor Elahi and explained the reason for the visit. Administrator/Licensee Nargis Elahi arrived shortly after. The Department received a complaint on 12/24/2024 and initial 10 day visit was conducted on 12/30/2024. During the visit, LPA Mendivil obtained copies of documents including medication adminstration record and admission agreement. LPA Mendivil interviewed staff and residents. Regarding the allegation licensee does not follow proper eviction procedure, the investigation revealed the following: It was alleged that facility is not following eviction procedures. Based on interviews with witnesess it was alleged the facility issued a 10 day evicition notice. Based on interviews with Administrator/Licensee Nargis it was reported that they have the right to issue a 3 day eviction if they are not able to meet the residents' needs. Substantiated Administrator/Licensee Nargis stated that they have never had to issue out an eviction and was under the impression she could issue an eviction sooner than 30 days if they are not meeting the resident's needs. Therefore, based on a preponderance of evidence through interviews and records reviewed the allegation Licensee did not follow proper eviction procedure, is determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred. The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8. An exit interview was conducted and a copy of this report and appeal rights was provided to the facility representative. Therefore, based on the preponderance of evidence through interviews the allegation that Facility does not have sufficient overnight staffing is determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint. No deficiencies cited. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 30, 2024 · control 22-AS-20241224104548

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(4) · Plan of correction due date: Jan 6, 2025

(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required...4) If, after admission, it is determined that the resident has a need not previously identified... ... and a reappraisal has been conducted pursuant to Section 87463. This requirement was not met as evidence by Licensee/Administrator issued a 10 day notice, this poses a potential risk to persons in care.the state’s words, verbatim · CDSS document, Dec 30, 2024

Plan of correction: Licensee reviewed 87224 Eviction Procedures and provided a signed copy of acknowledgement.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the second pre-licensing visit. LPA met with applicant Nargis Elahi. LPA and applicant toured the facility. LPA observed the following items have been corrected. LPA observed the fence on the side of the house has been replaced with a new fence that is not tilted or falling. LPA measured the hot water in both bathrooms and it measured 105.2 degrees Fahrenheit. LPA observed the PUB 475 poster is posted in the main entry of the facility and meets all the regulation requirements. LPA observed the front yard patio has been completed and has tables and chairs for outdoor use. LPA observed all the items on the side of the house have been cleared. LPA observed all the loose concrete blocks have been removed from the backyard and pavers (bricks) have been installed in the backyard. The facility now has a phone number. The facility phone number 949-795-2082. The fire extinguisher in the kitchen and the hallway are fully charged and mounted. All of the items noted on the first pre-licensing inspection have been corrected (See LIC 809 dated (August 13, 2024). Component III waived applicant is a Licensee/Administrator of a Licensed Facility. The facility is ready to be licensed. Applicant was informed today that the final approval will be processed by CAB (Cental Applications Bureau) in Sacramento. Exit interview was conducted and a copy of this report was provided to the applicant..the state’s words, verbatim · CDSS document, Sep 5, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicants Himal Thebe and Smriti Thebe and toured the facility. An initial application to operate an Adult Residential Facility (ARF) was submitted to CCL on March 4, 2024. The facility is to have a capacity of 6 non-ambulatory resident of which one can be bedridden. Resident room number one (1) is the only room approved for a bedridden resident. LPA observed the following. This is a change of ownership application with clients in care. Structure: The facility is a single story house with an attached 2 car garage with 7 bedrooms (room 4 is for staff), 2 bathrooms and a great room. Air/Heating: Central air/heating system installed with a central panel to control entire house. The air conditioning was operating during the visit. Resident Bedrooms: There are 6 resident Bedrooms and each bedroom is private. The bedrooms are spacious and will easily accommodate the clients' belongings. All client rooms had the required furnishings and linens. Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in the kitchen. The first aid kit has all the required elements. Medications will be stored in the kitchen cabinet and kept locked. Bathrooms: Both bathrooms have a working toilet, wash basin and walk in shower. Both bathrooms are clean and operational. Linens & Hygiene Supplies: Adequate supply of linen stored in hall closet. Extra hygiene supplies are stored in the garage. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food served for one week. Food Service: There is no food at the facility. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors tested operational. The fire extinguishers (2) are new and fully charged but they are not mounted. Appliances: There is a 5 burner gas stove which includes an oven, microwave oven and refrigerator in the kitchen. The washer and dryer are in the garage. All appliances are clean and operational. Toxins: The cleaning supplies are kept locked in the garage. Water Temperature: Hot water was measured in both bathrooms. Hot water measured at 122.5 to 123.0 degrees Fahrenheit. Client & Staff Files: The Client and Staff Records will be kept locked in the kitchen cabinet. Reading Material, Games, Equipment & Materials: Arts and craft, and board games are stored in the great room. There is a large screen TV mounted in the great room. At this time the facility does not have internet access. Fire clearance: Fire Clearance approved by Anaheim Fire Department Inspector Ruben Gomez on April 2, 2024. Component III: Component three waived. Applicant is a Licensee/Administrator of a Licensed Facility. Facility is not ready to be licensed. The following items must be completed prior to the facility being licensed. LPA observed the front yard patio is under construction and not yet completed. There is no shaded outdoor seating area for residents. The front yard covered patio must be completed and have seating for residents including table and chairs for outdoor use. LPA observed concrete blocks, tools and boxes stored on the side of the house by the exit gate. The side of the house must be cleared of all items except the garbage cans. The hot water must be adjusted to measure between 105.0 to 120.0 degrees Fahrenheit. The fence on the side of the house is being held up by pieces of wood that are not part of the original fence. The side fence must be repaired or replaced so it can stand on its own. LPA observed numerous paver bricks in the backyard stacked on the ground. The paver bricks must be removed or installed. The PUB 475 poster must be 20 by 26 inches and posted in the main entry way. The fire extinguishers must be mounted in the kitchen and hallway. Facility must have a phone number. Applicant was informed the must contact the LPA to schedule the second pre-licensing visit. Applicant was informed today that the final approval will be processed by CAB in Sacramento after the pre-licensing has been successfully completed. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Aug 13, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Nargis Elahi CEO/Administrator Interview Method: Telephone interview On June 18, 2024, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and 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 the 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 18, 2024