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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701686
Report Date: 10/23/2025
Date Signed: 10/23/2025 04:37:55 PM

Substantiated


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
10/20/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251020081614
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:
10/23/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lyenna BigelowTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff are not safeguarding resident belongings.
Staff do not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to open this complaint investigation. LPA Moleski met with facility administrator Lyenna Bigelow and explained the purpose of the visit.

LPA Moleski received a video taken by a resident of this facility (R1). In this video, R1 was heard raising concerns to a staff member (S1). R1 accused S1 of calling them names, such as a "drama queen." In response to these concerns, S1 said "oh, you're just miserable, that's all." R1 continued to raise their concerns. S1 then began to raise their voice considerably, and told R1 that they were being abusive toward them. S1 said that R1 was harassing them, and said they could call the police on R1 as a result. S1 suggested they may call the police on R1 multiple times. LPA Moleski met S1 in person during today's visit, and verified their identity. S1 confirmed that R1 had been taking videos of them, but said that they remained quiet and did their work, and only responded to say that R1 was being disrespectful.
[continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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 6
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
10/20/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251020081614

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:
10/23/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lyenna BigelowTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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2
3
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9
Staff are not allowing resident to use restroom closest to their bedroom.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to open this complaint investigation. LPA Moleski met with facility administrator Lyenna Bigelow and explained the purpose of the visit.

In an interview, a resident (R1) alleged that they were told by a staff member (S1) that the common bathroom was for caregiver use only, and R1 had to use a private bathroom in a resident room instead. S1 said they were using the common bathroom, and so for that reason requested that R1 use the private bathroom instead.

LPA Moleski interviewed all other residents of this facility (R2-R6). None of these residents reported restrictions upon bathroom use. The residents of the bedroom with the private bathroom did not raise any concerns regarding other residents using their bathroom. During LPA Moleski's visit, the common bathroom was open, unlocked, and accessible to clients in care. [continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20251020081614
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: 10/23/2025
NARRATIVE
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The department has determined the following as it relates to the allegation staff are not allowing resident to use restroom closest to their bedroom:

Based on interviews, the above allegation is UNSUBSTANTIATED, which 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.

No deficiencies were cited regarding this allegation. An exit interview was held and a copy of this report was left with Bigelow.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20251020081614
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: 10/23/2025
NARRATIVE
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In an interview, R1 said several personal items have gone missing since they moved in. R1's admission agreement indicates they moved in on 9/10/25. In an interview, S1 said they started working at this facility about two weeks ago. S1 was associated to this facility as of 10/14/25. S1 said that, when they started, R1 informed them that a hat and a bluetooth speaker were both missing. S1 said that the speaker was back in R1's possession as of 10/22/25, although their hat was found previously. In an interview, R1 said their bluetooth speaker went missing about three weeks prior to this visit, and they found it about two days ago. LPA Moleski reviewed R1's file. LPA Moleski observed no documentation regarding any loss of R1's property.

In an interview, R1 said their iPad also went missing the day before yesterday. R1 alleged that it was stolen. In an interview, Bigelow and S1 both said they were notified of this alleged theft on the morning of 10/22/25. HSC Section 1569.153(i) requires that licensees make a police report within 36 hours when they have reason to believe a theft has occurred involving property worth $100 or more. As it has been less than 36 hours since this report was made to Bigelow, this subsection has not been violated. R1 told LPA Moleski that they reported this alleged theft to local law enforcement during this visit. Officers arrived and met with R1.

HSC Section 1569.153(c) requires the following: "Documentation of lost and stolen resident property with a value of twenty-five dollars ($25) or more within 72 hours of the discovery of the loss or theft ... The documentation shall include, but not be limited to, the following: (1) A description of the article. (2) Its estimated value. (3) The date and time the theft or loss was discovered. (4) If determinable, the date and time the loss or theft occurred. (5) The action taken." LPA Moleski observed no such documentation in R1's file regarding their missing bluetooth speaker.

22 CCR Section 87218(a)(2) states that "The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to meet each requirement specified in Section 1569.153." A failure to document property loss, as required by HSC Section 1569.153, even if that property was later found, means that the licensee is presumed not to have made reasonable efforts to safeguard resident property.

LPA Moleski reviewed R1's personal property inventory and observed that no inventory was made of R1's property. A cross was drawn through the property inventory form. R1 and Bigelow both signed the form. HSC Section 1569.153(d) states that "The facility shall not be liable for items which have not been requested to be included in the inventory..." [continued on 9099-C]
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
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Control Number 27-AS-20251020081614
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: 10/23/2025
NARRATIVE
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The department has determined the following as it relates to the allegations that staff are not safeguarding resident belongings, and that staff do not treat resident with dignity and respect:

Based on interviews and record review, the above allegations are SUBSTANTIATED. A finding that the complaint allegations are substantiated means that the allegations are valid because the preponderance of evidence standard has been met. This facility is hereby cited per HSC Section 1569.153(c) and 22 CCR Section 87468.1(a)(1).

An exit interview was held with Bigelow. Appeal rights and a copy of this report were left with Bigelow.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20251020081614
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2025
Section Cited
CCR
87468.1(a)(1)
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"(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:

(1) To be accorded dignity in their personal relationships with staff, residents, and other persons." This requirement was not met as evidenced by:
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Licensee agrees to provide LPA Moleski with a training plan by POC due date.
vincent.moleski@dss.ca.gov
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Based on interviews and record review, S1 did not treat R1 with dignity, which poses an immediate health, safety, and/or personal rights risk.
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Type B
10/30/2025
Section Cited
HSC
1569.153(c)
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"(c) Documentation of lost and stolen resident property with a value of twenty-five dollars ($25) or more within 72 hours of the discovery of the loss or theft ... The documentation shall include, but not be limited to, the following..." This requirement was not met as evidenced by:
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Licensee agrees to review the applicable sections of HSC and to provide LPA Moleski with an acknowledgement.
vincent.moleski@dss.ca.gov
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Based on interviews and record review, documentation was not maintaned as required by Health and Safety Code.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6