<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701686
Report Date: 05/22/2026
Date Signed: 05/22/2026 02:14:39 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 Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260211112902
FACILITY NAME:GOLDEN HERITAGE SENIOR CARE IVFACILITY NUMBER:
342701686
ADMINISTRATOR:BIGELOW, YELENAFACILITY TYPE:
740
ADDRESS:3801 LAKE TERRACE DRTELEPHONE:
(916) 667-9761
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:6CENSUS: 6DATE:
05/22/2026
UNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Administrator: Yelena BigelowTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
The facility allowed excluded individuals to work in the facility.
The Administrator is not present at the facility for a sufficient amount of time.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/22/2026 Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Yelena and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 6.

Allegation: The facility allowed excluded individuals to work in the facility.
It was alleged that the facility allowed excluded individuals to work in the facility. This investigation consisted interviews with facility staff, residents, and records review. On 2/18/2026 LPA Hughes conducted a visit to the facility, LPA spoke with facility staff (S2) who stated that they primarily work in the facility five (5) days per week, and sometimes have relief by other facility staff, stating that she does not know their names. LPA spoke with 5 out of 5 residents in care who stated that (1) facility staff primarily works in the facility, and that they have not seen other staff working in the facility, since (S2) has worked in the facility.

Continuation 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026
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 2
Control Number 27-AS-20260211112902
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 IV
FACILITY NUMBER: 342701686
VISIT DATE: 05/22/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA showed (5) residents a photo of (2) excluded individuals and all residents denied observing the residents working in the facility. LPA reviewed facility records LIC 500 Personnel Report and did not observe the names of the excluded individuals on the staffing schedule. Additionally, LPA reviewed the Guardian facility staff rosters and did not observe the names of the excluded individuals on the staff roster. There is not enough information or evidence present to corroborate this allegation therefore the allegation is unsubstantiated.

Allegation: The Administrator is not present at the facility for a sufficient amount of time.
It was alleged that the Facility Administrator is not present at the facility for a sufficient amount of time. This investigation consisted of interviews with facility staff, and residents in care. On 2/18/2026 LPA conducted a visit to the facility, during the visit LPA spoke with facility staff (S2) who stated that the facility administrator is continuously present in the facility, stating that the administrator is present inside of the facility 2-3 times per week. LPA spoke with 3 out of 5 residents who stated that the facility administrator is present at least 1-3 times per week. There is not enough information or evidence present to corroborate this 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(s)occurred.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2