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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701257
Report Date: 03/10/2025
Date Signed: 03/10/2025 12:06:49 PM

Document Has Been Signed on 03/10/2025 12:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 IIFACILITY NUMBER:
342701257
ADMINISTRATOR/
DIRECTOR:		BIGELOW, YELENAFACILITY TYPE:
740
ADDRESS:3612 EASTERN AVETELEPHONE:
(916) 631-0694
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 6CENSUS: 6DATE:
03/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Yelena BigelowTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Holly Williams arrived unannounced to conduct an annual inspection. LPA Williams met with facility administrator Yelena Bigelow and explained the purpose of the visit. .

LPA Williams reviewed four resident files (R1-R4) and staff one staff file (S1).

LPAs Williams toured the facility with Yelena Bigelow and inspected common areas, the kitchen, bedrooms, bathrooms, garage, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 73 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 107.4 degrees Fahrenheit, which is below the required range of 105 and 120 degrees.

LPA Williams observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and carbon monoxide/smoke detectors. LPAs Williams observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Williams observed a locked cabinet for the storage of medication. LPA Williams observed locked cabinets for the storage of cleaning solutions and knives.

LPA Williams interviewed 1 staff member (S1) and 2 residents (R1-R2).

Appeal rights and a copy of this report were provided to Yelena Bigelow.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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