Golden Hills Care Home

Type of visit: Required - 1 Year

On 08/24/26 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced 1 year required visit. LPA announced the purpose of the visit and met with Carlo Basilio. During visit LPA toured the kitchen and observed locked cabinets for sharp object and cleaning supplies. LPA observed 2-day perishable and 7 day nonperishable food supplies. LPA observed the refrigerator temperature at 35 degrees F and freezer temperature at o degrees F. The facility room temperature displayed 80 degrees F. Fire Extinguisher was last purchased on 06/29/26. During visit LPA observed a can of Cleaning Supply(Comet) in both bathrooms. LPA toured resident bedrooms, each bedroom had bedding, lighting and storage area for resident belongings. LPA toured 2 resident bathrooms, water temperature in bathroom measured with thermometer at 110.1-110.4 degrees F. ADM tested the smoke detector in kitchen and found smoke detector function properly when tested. LPA reviewed 3 staff records and 3 resident records 2 out of 3 staff did not have CPR training. LPA and ADM reviewed the Centrally Stored Medication Record for 3 residents. LPA reviewed the fire and earthquake log. The facility last disaster drill was conducted on 05/28/2026. LPA toured the facility inside and out and observed exits to be clear and free of obstruction. Deficiences were cited as per California Code of Regulations Title 22. This report was reviewed with Carlo Basilio ADM and a copy of this report and appeals rights were provided.the state’s words, verbatim · CDSS document, Aug 24, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Carlo Basilio, Administrator (ADM). LPA announced the purpose of the visit. LPA observed 2 residents and 3 staff including Administrator. During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days LPA toured 4 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. ADM tested the smoke detectors in the hallway and found the smoke detector to function properly when tested. LPA toured two out two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 117.3 F. LPA toured the outside area and found the exits to be clear of obstructions. LPA observed fire extinguisher was purchased on 09/04/24. LPA reviewed Fire and Earthquake log. The last disaster drill was conducted on 05/13/25 LPA reviewed resident records for 2 residents. LPA reviewed 2 staff records, 1 out of 2 resident was missing initial and continued training. Centrally stored medication record was reviewed. Deficiency was cited as per California Code of Regulations Title 22 See LIC 809-D. This report was reviewed with Carlo Basilio and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 18, 2025

Allegation investigated: Staff over medicated resident. Staff did not meet the needs of the resident.

Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Licensee/Administrator, Carlo Basilio and stated the purpose of today’s visit. On 11/7/2022, the Department received a complaint with the above allegations. On 11/15/2022, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 2. Unsubstantiated Page 2 of 2. Staff over medicated resident. It was alleged that the facility staff were administering “as needed” (PRN) medication ever day to resident R1. On 11/15/2022, the Department conducted interviews with 2 staff (S1-S2) and ADM. Three out of three staff stated the facility staff administered medications as prescribed. ADM stated Hospice nurse audited R1’s medications and did not find anything. Based on review of R1’s medication list provided by hospice agency, R1 was administered 9 routine medications and 9 as needed (PRN) medications. Based on review of R1’s facility file, facility staff had retained physician’s orders provided by hospice physician on new medication orders effective on 10/18/2022 and 10/21/2022. Staff did not meet the needs of the resident. It was alleged that the facility staff did not provide assistance with ADLs. On 11/15/2022, the Department conducted interviews with 2 staff (S1-S2) and ADM. 3 Out of 3 staff stated the facility staff provided assistance with ADLs, which including taking R1 on walks, assisting R1 at night by cooking food when R1 requested and administering medications as prescribed by physician. Based on review of R1’s Preplacement Appraisal Information dated 10/14/2022 which was completed by R1’s Responsible Party, R1 had neurocognitive disorder and needed assistance with bathing, hair care, personal hygiene, medication, incidental health an medical care. This complaint was closed without investigation. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Licensee/Administrator, Carlo Basilio and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 30, 2024 · control 26-AS-20221107101910

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez conducted an unannounced case management visit to continue annual inspection from yesterday 8/28/2024. LPAs spoke with Licensee, Carlo Basilio over the phone and stated the purpose of today's visit. Licensee stated he could not be present at the facility due to scheduled appointment and Licensee gave verbal authorization for staff Leonida (Nida) Difuntorum to sign today's report on his behalf. LPA Rai observed 2 staff and 3 residents at the facility. Fire extinguisher was last serviced on 9/27/2019. Per Licensee, new fire extinguisher was purchased but could not provide receipt during yesterday's visit (8/28/2024). Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills which were conducted at the facility were not provided during today's visit. Per Licensee, staff are not aware where the disaster drill records are kept. During yesterday's inspection, LPA Rai reviewed facility records for 2 staff (S1-S2) and 2 residents (R1-R2). LPA Rai observed 2 out of 2 staff files did not contain SOC341A Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders. LPA Rai did not observe staff training provided for reporting suspected abuse of dependent adults and elders. LPA Rai observed 2 out of 2 resident files did not contain signed Personal Rights of Residents in All Facilities. LPA Rai observed 2 out of 2 resident files did not contain weight records where staff would measure resident's weight in pounds (lbs) or measurements of arms and/or thigh. LPA Rai observed 2 out of 3 resident files did not have signed Appraisal/Needs and Services Plan signed by resident and/or resident's responsible party. During todays visit, LPAs reviewed facility file for R3. LPAs observed R3's facility file did not contain a Physician's Report. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai reviewed resident medications and central stored medication records. LPA Rai observed 1 out of 2 resident files did not a Centrally Stored Medication Record for resident (R1)'s medications which were centrally stored. LPA Rai observed 3 residents using half-bed rails on their bed. 1 out of 3 residents is under Hospice services. 2 out of 3 resident (R1-R2) are not under Hospice services and use half-bed rail for mobility. LPA Rai observed R1 and R2's resident file did not contain written physician's orders for half-bed rails for mobility use. LPA Rai reminded Licensee Carlo Basilio under Health and Safety Code §1569.33 (a) Every licensed residential care facility for the elderly shall be subject to unannounced inspections by the department. The department shall inspect these facilities as often as necessary to ensure the quality of care provided. LPAs cited the deficiencies under CCR 87405 Administrator - Qualifications and Duties. Licensee/Administrator shall have knowledge of and ability to conform to the applicable laws, rules and regulations, such as Title 22 regulations and Health and Safety Code. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. Licensee and Administrator shall continue to work with licensing agency staff to remain professional during unannounced inspection visits. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. All Plan of Corrections (POC) for Type B deficiencies cited during today's visit will be due on Thursday, September 5th, 2024. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with staff Leonida (Nida) Difuntorum and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Aug 29, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87203 · Plan of correction due date: Sep 5, 2024

87203 Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on interview and observation, fire extinguisher inspected in the facility were last serviced on 09/27/2019 and a new fire extinguisher was purchased last year but no receipt was provided which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee will submit a written plan of action to ensure fire extinguisher is served yearly or purchased anew. POC will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC15655 · Plan of correction due date: Sep 5, 2024

§15655 Training on elder and dependent adult abuse;...all staff being trained a written copy of the reporting requirements and a written notification of the staff's confidentiality rights as specified in Section 15633. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above in 2 out of 2 staff files did not contain SOC341A which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee will provide a written plan of understanding the regulations. POC will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468(b)(1)(A) · Plan of correction due date: Sep 5, 2024

87486 Personal Rights (b)(1)(A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above in 2 out of 2 resident files did not contain a signed copy of Personal Rights of Residents in All Facilities which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee to submit a written plan of action to ensure resident's file contains a signed copy of Personal Rights of Residents in All Facilities and send to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87466 · Plan of correction due date: Sep 5, 2024

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes … such as unusual weight gains or losses … the licensee shall ensure that such changes are documented … This requirement is not met as evidenced by Based on record review, ADM did not keep a record of resident’s weight gains or losses to regularly observe any changes, which pose/poses a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee to submit a written plan of action to ensure observation of change of condition of the residents such as unusual weight gain or losses is documented. POC will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(b) · Plan of correction due date: Sep 5, 2024

87463(b) The licensee shall immediately bring any such changes to the attention of the resident's physician and his family or responsible person. This requirement is not met as evidenced by: Based on record review and interview, 2 out of 2 resident files did not contain Appraisal/Needs and Services Plan and Individual Service Plan signed by resident and/or responsible party which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee to submit a written plan of action to ensure Appraisal/Needs and Services Plan is signed by resident and/or responsible party. POC will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR80075(k)(7) · Plan of correction due date: Sep 5, 2024

(k)(7) The licensee shall ensure the maintenance, for each client, of a record of centrally stored prescription medications which is retained for at least one year and includes the following: This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above wherein 1 out of 2 resident’s medications which are centrally stored were not recorded and maintained poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee to submit a written plan of action to maintain a record of centrally stored prescription medications. POC will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(3) · Plan of correction due date: Sep 5, 2024

87608(a)(3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. This requirement is not met as evidenced by: Based on observation, interview, and record review 2 out of 2 residents did not have a physician's order on file for the use of half bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee to submit a written plan of action to maintain a written order from a physician to indicate the need for half-bed rail for mobility. POC will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.6959(c) · Plan of correction due date: Sep 5, 2024

(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. This requirement is not met as evidenced by: Based on observation and record review, the facility staff could not provide documentation on the disaster drills conducted at the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee to submit a written plan of action to maintain documentation on disaster drills conducted at the facility. POC will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458 · Plan of correction due date: Sep 5, 2024

87458 (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. This requirement was not met as evidenced by: Based on observation and record review, resident R3's file did not contain LIC 602 Physician's Report which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee to submit a written plan of action to maintain record of resident's medical assessment. POC will be submitted to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(d)(2) · Plan of correction due date: Sep 5, 2024

(d)The administrator shall have the qualifications...If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: Based on observation, interview &record review, the Licensee/Administrator did not comply with section cited above by not maintaining staff and resident files, maintaining fire extinguisher, maintaining records of disaster drill which poses/ posed a potential health, safety orthe state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Since Licensee was not present during today's visit, Licensee to submit a written plan of action understanding applicable laws, rules and regulations such as Title 22 and Health and Safety Code. POC will be submitted to LPA by POC due date. (con't) personal rights risk to persons in care.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Licensee, Carlo Basilio and stated the purpose of today's visit. LPA Rai observed 2 staff and 2 residents at the facility and 1 resident was out of the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed a shed used for storage space and not habitual space. In the garage, LPA Rai observed multiple mattress and personal items for staff S1. Licensee stated the garage is not being used as habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the resident bedrooms. 4 Out of 4 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sinks ranged from 109.2 - 109.4 degrees F. LPA Rai will return another day to complete annual inspection. This report was reviewed with Licensee, Carlo Basilio and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2024