Golden Hearts Senior Care

Type of visit: Required - 1 Year

At approximately 9:30am, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by Edwardson Manalo, Licensee. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for six (6), is approved for all non-ambulatory residents, and is vendored with the North Bay Regional Center (NBRC). At approximately 10:30am, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a two story home, was a comfortable temperature, and passageways were free from obstructions. All residents live on the first floor of facility. Staff and tenants who live on the second floor are background screened and associated to the facility. LPA observed egress devices activated on all facility doors. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPA inspected a locked storage shed in the backyard which contained care equipment. LPA observed residents watching TV in their bedrooms and in the facility's common area. Continued on LIC809-C... Continued from LIC809C... Facility has internet service and an internet access device which is designated for resident use. The telephone was tested and was operational during inspection. Smoke and carbon monoxide detectors were tested and operational during inspection. Fire extinguisher was observed fully charged and was last inspected 03/2025. Emergency Disaster Plan was reviewed and updated 09/2025. Facility conducts quarterly disaster drills with the most recent drill conducted 08/2025. LPA observed PPE, a first aid kit, flashlights, and a generator for emergency preparedness. At approximately 11:15am, LPA conducted file review of three (3) staff and three (3) resident files. Three (3) of three (3) staff files reviewed contained all the required documents including proof of current First Aid and CPR certifications. Staff 1 (S1) and Staff 2 (S2) records were missing proof of all 20 hours of the required annual training, (see LIC809D). Three (3) of three (3) staff files reviewed were observed to have the required initial training hours. Three (3) of three (3) resident files reviewed contained all the required documentation. Licensee states that residents' families and facility staff coordinate medical and dental appointments as well as transportation to a from these appointments. Medications and medication records were inspected and the logs were observed maintained in compliance with regulation. Licensee provided LPA with a copy of a surety bond and agrees to submit an affidavit regarding resident cash resources to the Department for any P&I the facility manages for residents in care. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC400 - Affidavit Regarding Client/Resident Cash Resources Proof of Liability Insurance (updated policy) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations, may result in a civil penalty assessment. Appeal rights provided to Licensee. Exit interview conducted with Licensee whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 5, 2025

Type of visit: Required - 1 Year

At approximately 9:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Edwardson Manalo and explained the purpose of the visit. Administrator certificate is current. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. All required postings were present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. LPA observed several expired food items in the garage. Licensee discarded the items immediately. Facility has the required seven-day non-perishable and two day perishable supply of food. Medication is locked and not accessible. All toxins were secured and not accessible. The facility was observed to be at a comfortable temperature. Water temperature measured within regulation. First aid kit was present. Facility has PPE supplies. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. Facility has been conducting drills every 3 months. At approximately 10:30AM, LPA reviewed 8 Staff records and 5 resident records. All resident files contained the required documentation. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. LPA received evidence of Liability insurance during this visit. No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.the state’s words, verbatim · CDSS document, Sep 9, 2024

Type of visit: POC

Licensing Program Analyst Leibert arrived unannounced for the purpose of verifying proof of correction from a deficiency issued on 08/13/2024. LPA met with the Administrator and reviewed the activity logs. LPA has verified that the activity logs have been completed and the facility has cleared the deficiency.the state’s words, verbatim · CDSS document, Sep 6, 2024

Allegation investigated: Staff do not allow residents to leave the facility

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. During the course of this investigation site visits were made; staff, residents and witnesses were interviewed as well as documents obtained and reviewed. Based on the statements and reviewed documents, the following determinations are made: Residents have differing opinions as to whether or not there are sufficient opportunities to leave the facility for community outings and have made contradictory statements regarding desire to leave facility; Staff state that they are prepared to arrange for transportation to the community when requested by residents or family; Facility's arrangements with third party transportation entities is in compliance with approved Plan of Operation. Although the allegation may be true, or valid, based upon the statements made, there is not a preponderance of evidence to prove or, disprove, the allegation. Therefore, the allegation is UNSUBSTANTIATED. Report left. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 13, 2024 · control 21-AS-20240315155856

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(a) · Plan of correction due date: Sep 13, 2024

87219(a) Planned Activites. Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities… Based on statements and documents, this requirement has not been met as evidenced by: During the month of July, 2024, none of the posted activities were offered or refused except for computer activity, walks, movies. Unannounced site visits indicate staff were not providing posted activities. This poses a potential denial of residents’ right to services.the state’s words, verbatim · CDSS document, Aug 13, 2024

Plan of correction: Administration to submit documentation of activities planned for residents over a 30 day period with notations indicating the activity, who participated or refused. Activities to be selected from approved sample activities calendar. Due by POC date in order to clear the deficiency

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso, conduct a Required- 1 Year inspection and met with Administrator Edwardson Manalo. There are currently two (2) residents on hospice care. Facility has a required infection control plan. Facility has a required emergency disaster plan. Facility has an approved hospice waiver for residents in care as needed. There is an approved plan of dementia care. Fire clearance is approved for six (6) non-ambulatory. The LPA reviewed four (4) client files. The LPA reviewed six (6) staff files. All staff had criminal record clearance as required. LPA toured the facility with Administrator. Hot water was checked 112.8 Fahrenheit. LPA observed all exits to be free of obstructions. Fire extinguisher is tagged and serviced as required. Napa Fire Department came out and inspected the fire alarm system, passed inspection, 8/8/2023. Facility's smoke alarms are also carbon monoxide detector; There are also two separate smoke alarms. Food supply was observed to be sufficient. The facility was clean and orderly. Facility had a sufficient supply of hygiene products, cleaners, and paper products. Facility had a sufficient supply of personal protective equipment (PPE). Bathrooms had roll in showers, grab bars, and mats for resident use. Facility had night lights for resident use as needed. LPA observed a 72 hour shelter in place supply, which is required. Licensee/Administrator to submit the following documents by 11/23/23: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 9020 Register of Residents LIC 610 E Emergency Disaster Plan for RCFE -reviewed & updated as needed Copy of current Liability Insurance Infection Control Plan-reviewed & updated as needed LIC400 Handling of Client Cash Resources, include copy of surety bond. Continued on LIC809C... The following deficiencies were cited: Based on LPA's file review, there were no documented records of facility's quarterly emergency drills. This will be cited, H&S Code 1569.695 ( c) a facility shall conduct a drill at least quarterly for each shift. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill, see LIC809D. Based on LPA's file review, Three (3) out of five (5) staff did not have a completed health screening report, including a TB test and results.This deficiency will be cited, 87411 (f) Personnel Requirements - General-all personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure, see LIC809D. Based on LPA’s file review, S1 didn’t have an annual medical assessment which is required, this will be cited, Care of Persons with Dementia 87705 (c ) (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with the Licensee/Administrator Edwardson Manalo. Appeal rights provided to the Administrator Edwardson Manalo.the state’s words, verbatim · CDSS document, Oct 23, 2023