Golden Heritage Senior Care II

Allegation investigated: ) The facility allowed excluded individuals to work in the facility. 2) Staff are forging resident documents. 3) The Administrator is not present at the facility for a sufficient amount of time.

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection at Golden Heritage Senior Care II (RCFE) on 7/17/26 at 1:40pm to conclude the investigation of the above allegation and to deliver the findings. LPA Gould met with staff, Temo Rocotabula and together discussed the investigation details. Based on files obtained and reviewed during the investigation process, LPA Gould was unable to corroborate the allegation. LPA reviewed 4 resident files. LPA requested and obtained physician reports (LIC 602) for all 6 residents in care (see confidential name list LIC-811 dated 7/17/26). LPA Gould reviewed reports for each resident. Upon review, the department has no concerns for five of the six physician reports are being altered or fraudulent. The files reviewed appear to be completed by the resident’s physician or an appropriately skilled professional that are able to complete the forms per department regulations. Report Continued on LIC 9099-C Unsubstantiated Additionally, LPA conducted interviews with two staff members and three residents. All staff interviewed denied excluded individuals presence at the facility and had knowledge they are not allowed at any licensed facility. The three residents interviewed denied witnessing any individuals identified in the complaint as being present at the facility or did not recognize photos of the identified individuals. All staff interviewed knows who the administrator is. All three residents interviewed were able to identify who the facility administrator is and identified her most recent working date. All residents interviewed identified the administrator present on a regular basis. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Other are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 17, 2026 · control 27-AS-20260211132336

Type of visit: Required - 1 Year

On 3/27/26 1:10pm Licensing Program Analyst (LPA) Kevin Gould arrived at Golden Heritage Senior Care for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Yelena Bigelow and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA observed one pill, pre poured and unsecured in a drawer. LPA provided advisory notes. LPA measured the water temperature, temperature measured at 108 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 27, 2026

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff refused to allow resident readmission to facility.

On 11/25/2025 at 9:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility staff Kinisimere and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegation above. The current census is 6. Allegation: Staff refused to allow resident readmission to the facility It was alleged that staff refused to allow resident readmission to the facility. This investigation consisted of interviews with facility staff, the reporting party, and records reviewed. On 10/2/2025 LPA Hughes conducted a visit to the facility, interview with facility staff (S1) indicated that resident (R1) was re-admitted back into the facility following a rehabilitation stay at a Skilled Nursing Facility (SNF) from 9/11/2025 to 10/3/2025. Interview with the reporting party (RP) indicated that there was a delay in R1’s re-admission to the facility. However, resident (R1) was provided reassessment by the facility, and was subsequently re-admitted. Continuation 9099-C Unsubstantiated LPA reviewed resident R1’s records and it was reflected that the resident requires increased assistance with ADLs including incontinent care which was provided to the resident through a Home Health agency upon the residents discharge from the SNF into the facility. Upon review of the information provided, there is not enough evidence to corroborate the allegation, therefore the allegation is unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.the state’s words, verbatim · CDSS document, Nov 25, 2025 · control 27-AS-20250925120014

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Holly Williams arrived unannounced to conduct an annual inspection. LPA Williams met with facility administrator Yelena Bigelow and explained the purpose of the visit. . LPA Williams reviewed four resident files (R1-R4) and staff one staff file (S1). LPAs Williams toured the facility with Yelena Bigelow and inspected common areas, the kitchen, bedrooms, bathrooms, garage, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 73 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 107.4 degrees Fahrenheit, which is below the required range of 105 and 120 degrees. LPA Williams observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and carbon monoxide/smoke detectors. LPAs Williams observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Williams observed a locked cabinet for the storage of medication. LPA Williams observed locked cabinets for the storage of cleaning solutions and knives. LPA Williams interviewed 1 staff member (S1) and 2 residents (R1-R2). Appeal rights and a copy of this report were provided to Yelena Bigelow.the state’s words, verbatim · CDSS document, Mar 10, 2025

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a postlicensing inspection. LPA Moleski met with facility administrator Yelena Bigelow and explained the purpose of the visit. When LPA Moleski arrived, he was met by a staff member (S1). LPA Moleski reviewed Guardian records and observed that S1 was not associated to this facility. S1 told LPA Moleski S1 had been working at this facility for about two to three months. Bigelow submitted a transfer request and S1 was associated during this visit. S1 showed LPA Moleski a closet containing cleaning solutions and other cleaning supplies. S1 said the lock to the closet had been broken since approximately 11 p.m. the previous night. Bigelow removed the cleaners during this visit. LPA Moleski reviewed five resident files (R1-R5) and one staff file (S1). LPA Moleski toured the facility with Bigelow and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. While inspecting the kitchen, LPA Moleski observed several medications being stored in an unlocked cabinet. LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and working 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 locked cabinet for the storage of medication. LPA Moleski observed a locked box for the storage of knives. LPA Moleski interviewed one staff member (S1) and two residents (R2-R3). This facility is hereby cited per 22 CCR Sections 87309(a), 87465(h)(2), and 87355(e)(3). A civil penalty in the amount of $100 per day worked by S1 for a maximum of five days is hereby assessed. An exit interview was held with Bigelow. Appeal rights and a copy of this report were left with Bigelow.the state’s words, verbatim · CDSS document, May 20, 2024

Type of visit: Prelicensing

On March 07, 2024 at 2:20 PM, Licensing Program Analyst (LPA) Avelina Martinez arrived unannounced to conducted a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Avelina Martinez met with Penina Tuimaualuga who assisted LPA Martinez in today’s inspection. Facility has a fire clearance for 1 ambulatory resident and 5 non-ambulatory residents. Bedrooms 1, 2, 3, and 6 are permitted for non-ambulatory resident use. Moreover, rooms 4 is not permitted for staff or resident use, and it is only permitted for storage. Rooms 5 is only permitted for staff use. Yelena Bigelow, will be the Administrator of this facility. The facility administrator’s certificate is current, and it expires on February 01, 2025. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA toured the facility with Penina Tuimaualuga on March 07, 2024. During today's pre-licensing visit, LPA Martinez observed the following items to be in good repair and in compliance : Facility door locks and knobs Wheelchair Ramps Patio tiles Cleanliness of facility Food supply Emergency exit gate/free of debris. Resident files-LIC 602 and Needs and Service Plans- Fire Clearance (no bedridden residents) The applicant has passed the pre-licensing component of the application process. LPA Martinez will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. Component 3 waived due to previous review of component 3. An exit Interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Mar 7, 2024

Type of visit: Case Management - Other

Licensing Program Analysts (LPA) Avelina Martinez and Jaime Ivy-Canady arrived at this facility unannounced on 01/25/2023 at 9:00 AM to conduct a case management visit. LPAs met with Yelena Bigelow and Pennina Tuimaualuga and explained the purpose of the visit. The purpose of the visit today, is in response to follow up on plan of corrections for deficiencies cited on January 11, 2024. LPAs toured the facility with Pennina Timaualuga on 01/25/2024. During the tour, LPAs observed the patio tiles continue to be raised off the ground creating a tripping hazard. In addition, room 3 dresser is blocking the closet door, which is making the closet inaccessible. Moreover the front door locks from the outside, and residents are not able to re-enter into the facility without having staff let them back into the facility. LPAs conducted a resident file review, and LPAs obtained copies of resident documents. Pennina Tuimaualuga reported the landlord will be working on repairing the patio tiles. LPAs were informed a contractor would inspect the patio no later than February 02, 2023. LPA Jaimie Ivy-Canady will conduct a plan of correction visit to follow up on deficiency. Pennina Tuimaualuga agrees to email LPA Jaimie Ivy-Canady plan in regards to front door, room 2 and room 6 exit door locks by 01/26/2024 5:00 PM. No deficiencies cited at this time. An exit interview was conducted, and a copy of this report was provided at the end of visit.the state’s words, verbatim · CDSS document, Jan 25, 2024

Type of visit: Prelicensing

On January 11, 2024 at 9:00 AM, Licensing Program Analysts (LPAs) Avelina Martinez and Jaime Ivey-Canady arrived unannounced to conducted a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPAs Martinez and Ivey-Canady met with Yelena Bigelow, who assisted LPAs in today’s inspection. Facility has a fire clearance for six non- ambulatory residents. Bedrooms 1, 2, 3, and 6 are designated for non-ambulatory resident use only. Bedroom 5 is designated for staff use only. Storage room shall only be used for storage. Facility has an approved hospice waiver for 1. LPS will follow up on Dementia program plan. Administrator, Yelena Bigelow has been the assigned to the facility. The facility administrator’s certificate expires on 02/01/2025. LPAs inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. LPAs toured both indoor and outdoors of the facility with Yelena Bigelow on 01/11/2024 at 10:00 AM. Physical Plant: Based on inspection of the physical plant, Title 22 regulations are not met according to the following: Facility is not sanitary and in disrepair: Air filter in the main hall is covered in dust, Front screen door is not in good repair, and main door will not close properly if screen door is closed. Blinds in room 1 are broken and in disrepair. Window sill in Room 1 have an accumulation of dead pests and spider webs. Rooms 2 and 6 door to the outside do not lock from the inside, and doors will automatically lock from the outside, which residents will not be able to re-enter their room from the outside. In addition, facility staff did not have keys for room door 2 and room door 6. The toilet in Room 3 is not maintained and clean. The bathroom toilet was not sanitary. Continued... Bedroom 6 is not furnished and is not set up for resident use. Bedroom 3 dresser is blocking the the closet door making the closet inaccessible. Carbon detector located in the hallway was missing a battery and not in good repair. The Administrator inserted batteries, and carbon detector is working properly. The exterior patio tiles are raised and causing a tripping hazard. There are glass windows and furniture next to emergency exit gate. Facility does not have sufficient staff to meet facility needs and care and supervision of residents in care. Facility has resident 1 that is in bed most of the day due to weakness in legs, and has a hoyer hoyer lift. Resident 1 requires stand by assistance at all times, and is a two person assist. Facility assessments also state resident 1 is not able to climb stairs require help with all activities of daily living. The facility has one non-ambulatory resident with a hoyer lift. This pre-licensing is a result of a change of ownership (CHOW). Please see case management report dated 01/11/2024 for deficiencies found during pre-licensing visit. The Administrator agrees to make all repairs by 01/19/2024 by 5:00 PM. The following items will be repaired Clean resident bathrooms Clean Window Sills Repair front window screen door Room 2 and 6 door locks need to be replaced (residents should be allowed to reenter their room from the outside and not be locked out). Remove furniture and debris from exterior back yard (furniture and debris next to fire emergency gate) The pre-licensing process will be completed after staffing issues have been addressed, fire clearance issues (to determine if residents are bedridden. Unknown at this time due to missing LIC 602 physician report) have been addressed, and Administrator hours issues have been addressed. The applicant has not passed the pre-licensing component of the application process. LPAs will notify the Central Application Bureau (CAB) that the pre-licensing has not been completed. An exit interview was conducted, and a copy of this report has been provided to the facility.the state’s words, verbatim · CDSS document, Jan 11, 2024