306006529-5-20-2026-22-AS-AORZ-DV4288-20260615170956

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006529
Report Date: 05/20/2026
Date Signed: 05/20/2026 11:20:09 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/10/2025 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20250110122555

FACILITY NAME:	GOLDEN HEARTS ELDERLY CARE 2		FACILITY NUMBER:	306006529
ADMINISTRATOR:	ELAHI, NARGIS		FACILITY TYPE:	740
ADDRESS:	25231 ROMERA PLACE		TELEPHONE:	(949) 716-0016
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	6	CENSUS:	DATE:	05/20/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Nargis Elahi - Administrator		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff overmedicated a resident while in care
Staff interfered with a resident's telephone call
Staff did not ensure a resident consumed an appropriate amount of liquids while in care
Staff did not meet a resident's hygiene needs
Staff mishandled a resident's pacemaker monitor
Staff retaliated against resident while in care

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit.

The Department received a complaint on 01/10/2025 and LPA Mendivil conducted the initial 10-day visit on 01/16/2025. During the initial visit LPA Mendivil obtained copies of physician report, medication administration records and resident appraisal for Resident 1 (R1). Regarding the allegations staff overmedicated a resident while in care, staff interfered with a resident’s telephone call, staff did not ensure a resident consumed an appropriate amount of liquids while in care, staff did not meet resident hygiene needs, staff mishandled a resident’s pacemaker monitor and staff retaliated against resident while in care, the investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026

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 22-AS-20250110122555

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GOLDEN HEARTS ELDERLY CARE 2	FACILITY NUMBER: 306006529
	VISIT DATE: 05/20/2026

NARRATIVE

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Resident 1 (R1) moved into the facility in November 2024 with a diagnosis of senile degeneration of the brain. It was alleged R1 was over medicated on or around January 06, 2025 when a medicated topical cream was over applied. Per interviews with 2 out of 2 staff indicated they do not over medicate residents and they follow all physician’s orders. Per interview with hospice nurse there were no concerns about R1 being over medicated. Per review of medication administration records R1’s medication appear to be given as prescribed.

It was alleged that staff interfered with a resident’s telephone call. Per interviews with 2 out of 2 staff indicated that they have never interfered with resident’s telephone calls. 5 out of 5 residents interviewed stated their calls are not interfered with or interrupted.

It was alleged that staff did not ensure a resident consumed an appropriate amount of liquids in care. Per interviews with 2 out of 2 staff stated residents are provided water and liquids throughout the day and are encouraged to drink water. 5 out of 5 residents interviewed stated they have a water cup with them daily. LPA Mendivil observed all residents to have their own water cup near and the cups were full. Per interview with R1’s hospice nurse indicated there was no issues with R1’s hydration.

It was alleged that staff did not meet resident hygiene needs. Per interview with R1’s hospice nurse it was reported that hospice’s bath aid would come 3-4 times per week. Interview with hospice nurse reported that R1 appeared to be clean. Interviews with 2 out of 2 staff stated if R1 needed more assistance with hygiene they would provide assistance. Based on interviews with 5 out of 5 residents stated they are assisted with hygiene needs.

It was alleged that staff mishandled a resident’s pacemaker monitor. Per review if R1’s LIC 602 Physician’s Report dated November 20, 2024 did not mention a use of a pacemaker. No photographs, medical records or documentation could be found to verify the presence of a pacemaker for R1. Administrator Nargis Elahi stated no one told her about R1 having a pacemaker, but had they she would not unplug the monitor.

It was alleged staff retaliated against resident. Per interviews with 2 out of 2 staff stated they did not retaliate against any resident. Staff stated they have not acted negatively or rude to any resident. Interviews with 5 out of 5 residents stated the staff is kind and respectful.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250110122555

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GOLDEN HEARTS ELDERLY CARE 2	FACILITY NUMBER: 306006529
	VISIT DATE: 05/20/2026

NARRATIVE

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Therefore based on the preponderance of evidence through records reviewed and interviews the allegations staff over medicated a resident while in care, staff interfered with a resident’s telephone call, staff did not ensure a resident consumed an appropriate amount of liquids while in care, staff did not meet resident hygiene needs, staff mishandled a resident’s pacemaker monitor and staff retaliated against resident while in care are determined to be UNSUBSTANTIATED meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies are being cited in today's visit.

An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026

LIC9099 (FAS) - (06/04)

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