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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701257
Report Date: 11/25/2025
Date Signed: 11/25/2025 09:55:30 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/25/2025 and conducted by Evaluator Shakaricka Hughes
COMPLAINT CONTROL NUMBER: 27-AS-20250925120014
FACILITY NAME:GOLDEN HERITAGE SENIOR CARE IIFACILITY NUMBER:
342701257
ADMINISTRATOR:BIGELOW, YELENAFACILITY TYPE:
740
ADDRESS:3612 EASTERN AVETELEPHONE:
(916) 631-0694
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 6DATE:
11/25/2025
UNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Facility Staff: Kinisimere BolaugaTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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9
Staff refused to allow resident readmission to facility.
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20250925120014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GOLDEN HERITAGE SENIOR CARE II
FACILITY NUMBER: 342701257
VISIT DATE: 11/25/2025
NARRATIVE
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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.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2