286804071-7-7-2023-21-AS-BMOS-CWNMY7-20231016100104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286804071
Report Date: 07/07/2023
Date Signed: 07/07/2023 12:53:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2023 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230628160115

FACILITY NAME:	GOLDEN HEARTS SENIOR CARE, LLC		FACILITY NUMBER:	286804071
ADMINISTRATOR:	MANALO, EDWARDSON		FACILITY TYPE:	740
ADDRESS:	1630 ARCADIA COURT		TELEPHONE:	(415) 770-4285
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	6	CENSUS: 5	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Edwardson Manalo-Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility meals are served more than fifteen (15) hours apart
Facility is not providing snacks between meals
Facility violated the resident's personal rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 7/7/2023 at approximately 10:00am, LPA met with Edwardson Manalo, Administrator.

LPA reviewed five (5) resident files. All resident files had required record. LPA interviewed staff, and other related interested parties regarding the allegations. The investigation revealed that the facility has a plan of meal times, breakfast 6-7:30am, lunch 11-12pm, and dinner 5-6pm; S1 stated that all meals can be provided a little later, some of our residents eat breakfast later than 7:30am but that would be their choice. S1 stated that snacks are scheduled for 9-9:30am, 2-3pm, and 7:30-8pm, these are provided to all residents, and can also be given by residents time preference if not wanting it by the schedule.

Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20230628160115

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GOLDEN HEARTS SENIOR CARE, LLC	FACILITY NUMBER: 286804071
	VISIT DATE: 07/07/2023

NARRATIVE

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Per interviews with staff and other parties dinner is served from 5pm to 6pm. Per interviews with staff and other parties, the residents may go to bed when they want to. Staff will help the residents get prepared for bed and residents may go to bed when they choose. The LPA toured the facility with the Administrator. LPA observed the food supply to be sufficient, perishable and nonperishable food. Facility was at a comfortable temperature during the inspection. Facility was clean and orderly. The LPA reviewed regulations regarding food service, and resident personal rights, and discussed with the Administrator to ensure compliance with regulations regarding the operation of the facility. The Administrator stated their understanding of the regulations discussed.

Based on the interviews, record/document reviews, and related information obtained during the investigation, the LPA found differing information provided by interviewed parties. The LPA was not able to obtain sufficient information to support that violations had occurred.

Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegations, facility meals are served more than fifteen (15) hours apart, facility is not providing snacks between meals, and facility violated the resident's personal rights, are Unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies cited during todays visit.
Exit interviews were conducted.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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