342701574-7-17-2026-27-AS-APAA-DWHR76-20260731124549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701574
Report Date: 07/17/2026
Date Signed: 07/17/2026 02:42:14 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 Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20260211114643

FACILITY NAME:	GOLDEN HERITAGE SENIOR CARE III		FACILITY NUMBER:	342701574
ADMINISTRATOR:	ALITI WAQALALA		FACILITY TYPE:	740
ADDRESS:	320 BOWMAN AVE		TELEPHONE:	(916) 631-0694
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95833
CAPACITY:	6	CENSUS: 6	DATE:	07/17/2026
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Eliese Qioele		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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1) 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.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection at Golden Heritage Senior Care III (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, Eliese Qioele 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

Estimated Days of Completion:

SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026

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 27-AS-20260211114643

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 III	FACILITY NUMBER: 342701574
	VISIT DATE: 07/17/2026

NARRATIVE

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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.

SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026

LIC9099 (FAS) - (06/04)

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