345002876-8-18-2025-59-AS-LCRR-DKZVCW-20250829161948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002876
Report Date: 08/18/2025
Date Signed: 08/18/2025 04:07:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
06/23/2025 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 59-AS-20250623114842

FACILITY NAME:	GOLDEN MOMENTS CARE HOME WINDING WAY		FACILITY NUMBER:	345002876
ADMINISTRATOR:	DAHLEY, DALEE		FACILITY TYPE:	740
ADDRESS:	4316 ILLINOIS AVENUE		TELEPHONE:	(916) 474-4678
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 2	DATE:	08/18/2025
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Stephanie Harmon-Christensen, House Manager		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Facility staff are not providing assistance with hygiene for residents in need.

Facility staff are not providing assistance with incontinence care for residents in need.

Staff are mistreating the residents in care.

Staff do not ensure that facility is clean.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Manager, Stephanie Harmon-Christensen, to deliver findings into the complaint allegations listed above.

During the investigation, the Department toured the premises, conducted interviews, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Facility staff are not providing assistance with hygiene for residents in need.

** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025

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 4

Control Number 59-AS-20250623114842

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GOLDEN MOMENTS CARE HOME WINDING WAY	FACILITY NUMBER: 345002876
	VISIT DATE: 08/18/2025

NARRATIVE

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LPA Sarah Benson conducted an inspection of the care home on July 1, 2025. LPA Benson reported touring the premises and conducting an interview with House Manager. Interview with House Manager indicated that residents at the care home shower twice a week. Staff reported the residents have never refused showers. LPA Benson observed the shower log for residents (R1 and R2) and observed two (2) showers recorded a week for both residents, with an exception of one (1) week for each resident in which one (1) shower was given.

LPA Michael Hood conducted an inspection of the care home on August 18, 2025. Interviews conducted with House Manager, Licensee, Mark Graham, and R2 did not indicate any concerns regarding hygiene assistance provided to the residents in care. R2 stated that they are treated well by facility staff and they feel that their care needs are being met. House Manager and Licensee stated that residents receive showers twice a week. House Manager, Licensee, and R2 stated that they have never witnessed a resident in need of showers and not receiving assistance by facility staff. Interview with witness (W1) indicated that they have observed R1 soiled at the care home on one (1) occasion, but did not have any other concerns regarding showers and did not have any information regarding how long R1 was soiled. LPA Hood observed shower records for R2 for the month of June 2025. LPA Hood observed that R2 received two (2) showers a week. Local Long-Term Care Ombudsman (LTCO) reported to LPA Hood that they conducted a visit at the care home and did not observe any concerns regarding hygiene assistance for the residents in care.

Allegation: Facility staff are not providing assistance with incontinence care for residents in need.

LPA Sarah Benson conducted an inspection of the care home on July 1, 2025. LPA Benson reported touring the premises and conducting an interview with House Manager. LPA Benson reported observing the bedding of R1 and R2 and observing bedding to be clean. Interview with House Manager indicated that the residents' sheets are changed every shower day unless residents refuse, and laundry is done every shower day.

** Report continued of 9099-C **

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20250623114842

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GOLDEN MOMENTS CARE HOME WINDING WAY	FACILITY NUMBER: 345002876
	VISIT DATE: 08/18/2025

NARRATIVE

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LPA Michael Hood conducted an inspection of the care home on August 18, 2025. Interviews conducted with House Manager, Licensee, and R2 did not indicate any concerns regarding incontinence care provided to the residents in need. R2 stated that they are treated well by facility staff and they feel that their care needs are being met. House Manager and Licensee stated that residents are checked every two (2) hours to see if they are in need of incontinence care. House Manager, Licensee, and R2 stated that they have never witnessed a resident in need of incontinence care and not receiving it by facility staff. Interview with W1 indicated that they have observed R1 soiled at the care home on one (1) occasion, but did not have any other concerns regarding incontinence care and did not have any information regarding how long R1 was soiled. LTCO reported to LPA Hood that they conducted a visit at the care home and did not observe any concerns regarding incontinence care for the residents in need.

Allegation: Staff are mistreating the residents in care.

LPA Sarah Benson conducted an inspection of the care home on July 1, 2025. LPA Benson reported touring the premises and conducting an interview with House Manager. Interview with House Manager indicated that they have never yelled at the residents in care.

LPA Michael Hood conducted an inspection of the care home on August 18, 2025. Interviews conducted with House Manager, Licensee, W1, witness (W2), and R2 did not indicate any concerns regarding staff mistreating the residents in care. R2 stated that they are treated well by facility staff and they feel that their care needs are being met. House Manager, Licensee, W1, W2, and R2 stated that they have never witnessed residents being mistreated at the facility. LTCO reported to LPA Hood that they conducted a visit at the care home and did not observe any concerns regarding staff mistreating the residents in care.

Allegation: Staff do not ensure that facility is clean.

LPA Sarah Benson conducted an inspection of the care home on July 1, 2025. LPA Benson reported touring the premises. LPA Benson observed the house to be clean, tidy, and free of odor. LPA Benson observed bedding for R1 and R2 to be clean.

** Report continued on 9099-C **

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20250623114842

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GOLDEN MOMENTS CARE HOME WINDING WAY	FACILITY NUMBER: 345002876
	VISIT DATE: 08/18/2025

NARRATIVE

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LPA Michael Hood conducted an inspection of the care home on August 18, 2025. Interviews conducted with House Manager, Licensee, W1, W2, and R2 did not indicate any concerns regarding the facility being unclean, malodorous, or in disrepair. During inspection, LPA Hood toured the premises and observed care home to be clean, in good repair, and free of odor. LPA Hood observed Cleaning Chart for All Shifts to be posted in the home, which documented housekeeping tasks completed by staff. House Manager and Licensee stated that housekeeping is conducted daily. LTCO reported to LPA Hood that they conducted a visit at the care home and observed home to be clean and in good repair.

Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025

LIC9099 (FAS) - (06/04)

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