342701261-7-24-2026-27-AS-SRIN-DWPR3H-20260806123957

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701261
Report Date: 07/24/2026
Date Signed: 07/24/2026 12:49:18 PM

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
02/11/2026 and conducted by Evaluator Christina Valerio

COMPLAINT CONTROL NUMBER: 27-AS-20260211122308

FACILITY NAME:	GOLDEN HERITAGE SENIOR CARE		FACILITY NUMBER:	342701261
ADMINISTRATOR:	BIGELOW, YELENA		FACILITY TYPE:	740
ADDRESS:	37 MOSSGLEN CIR		TELEPHONE:	(916) 631-0694
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95826
CAPACITY:	6	CENSUS: 6	DATE:	07/24/2026
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Siteri Sentiaru		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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

INVESTIGATION FINDINGS:

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icensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint findings. LPA Valerio met with direct care staff, and explained the purpose of the visit. LPA Valerio spoke to Administrator Yelena who gave permission for staff on shift to sign on her behalf. LPA Valerio read the report to Administrator via cell phone.

The investigation consisted of interviews with residents, interview with staff, a review of facility records, and personal observation of the facility.

Allegation: The facility allowed excluded individuals to work in the facility.

On 02/19/2026, LPA Valerio conducted an unannounced visit. LPA Valerio did not see excluded individual 1 (EI-1) or excluded individual 2 (EI-2) present in the facility.
Continues on LIC 9099 - C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026

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 3

Control Number 27-AS-20260211122308

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	FACILITY NUMBER: 342701261
	VISIT DATE: 07/24/2026

NARRATIVE

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LPA Valerio interviewed facility staff. Facility staff denied ever seeing EI-1 or EI-2 in the facility. LPA Valerio interviewed Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), Resident 4 (R4), Resident 5 (R5), and Resident 6 (R6). Residents were shown pictures of EI-1 and EI-2 and asked if they have seen the individuals or know their names. R1 did not recognize the people in the pictures. R2's interview was unsuccessful and could not confirm or deny any information. R3 denied ever seeing the individuals and stated R3 did not know them. R4 stated R4 has seen EI-1 and EI - 2 at the grocery store before. LPA asked if R4 seen them at the facility, R4 stated no. LPA asked the names of the people in the picture. The names provided by R4 did not match the names of the individuals. R5 stated R5 does not know the individuals in the picture and R5 is glad to be aware that they are not allowed to be at the facility. R6 was unaware of the individuals in the photo and has not seen them before.

Allegation: Staff are forging resident documents

On 02/19/2026, LPA Valerio obtained LIC 602 Physician Reports for R1 - R6. LPA Valerio contacted the physician and/or health center documented on the LIC 602. LPA was unable to confirm validity for R1's LIC 602. LPA was able to confirm the validity of the doctors signature for R2's LIC 602. LPA was able to confirm the validity of the doctors signature for R3's LIC 602. LPA was unable to confirm validity for R4's LIC 602. LPA Valerio could not confirm or deny the signature for R5's LIC 602 due to the number being out of service. LPA was able to confirm the validity of the doctors signature for R6's LIC 602.

Allegation: The Administrator is not present at the facility for a sufficient amount of time.

Staff 1 stated Administrator Yelena comes every week and will come for one or few hours. If staff need additional assistance, Administrator Yelena will come to the facility.

R1 stated the administrator comes every week. R2's interview was unsuccessful and could not confirm or deny any information. R3 stated R3 does not know who Yelena is. R4 stated R4 did not know who Yelena is. R5 knows Administrator Yelena comes to the facility every week, but cannot recall exact days and times. R6 knows Administrator Yelena comes to the facility every week and stated "She comes when she comes."

Continues on LIC 9099 - C, page 3...

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20260211122308

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	FACILITY NUMBER: 342701261
	VISIT DATE: 07/24/2026

NARRATIVE

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Yelena stated she is at the facility at least twenty (20) hours per week. She stated that it varies, honestly. She stated it can be more or less depending on which facility needs me more.

According to the LIC 500, Administrator Yelena is at the facility every Monday, Tuesday, Wednesday, Thursday and Friday from 8:00 AM to 12:00 PM.

Based on all the information collected by the Department, although the allegation may have happened or is valid, here is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED.

California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was held with Administrator Yelena via cell, and a copy of report was left at the facility with facility staff.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026

LIC9099 (FAS) - (06/04)

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