Golden Hill Homes, Inc.

On 4/7/2026 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Fathma Ansari and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 116.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 02/24/2026. First aid kit was observed to be complete. Emergency Disaster plan last reviewed on 2/1/2026. Emergency disaster drill was last conducted on 3/1/2025. At 10:00 AM, LPA reviewed 4 of 4 residents records. At 10:30 AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 4/20/2026: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 3/26/2025 at 8:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Fathma Ansari and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 117.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 03/19/2025. First aid kit was observed to be complete. Emergency Disaster plan last reviewed on 3/26/2025 .Emergency disaster drill was last conducted on 3/1/2025. At 9:00 AM, LPA reviewed 6 of 6 residents records. At 9:30 AM, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 4/09/2024 at 10:15 AM, Licensing Program Analysts (LPAs) A. Gomez and A. Gharachorloo arrived unannounced to conduct Required 1 Year Annual inspection. LPAs met with Administrator, Fathma Ansari and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 113.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 03/04/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 1/28/2024. At 10:30 AM, LPAs reviewed 5 of 5 residents records. At 10:50 AM, LPAs reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 10/20/2023 at 1:32 PM, Licensing Program Analysts (LPAs) P. Watson and A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. LPAs met with Administrator, Fathma Ansari and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 115.1 and 113.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 02/10/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 08/11/2023. Report continues on 809 C 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 At 1:53 PM, LPAs reviewed 5 of 5 residents records. At 2:15 PM, LPAs reviewed 5 of 9 staff records and 5 of 5 have current first aid training and associated to the facility. At 3:15PM, LPAs reviewed a sample of 5 of 5 resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 5/6/2022 at 10:00 AM, Licensing Program Analyst (LPAs) L. Francisco and K. Nguyen arrived unannounced to conduct a Pre-licensing Inspection. Upon arrival, LPAs were greeted by Care Staff, Rodora Suzon. Administrator, Fathma Ansar later arrived at 10:24 AM. The facility's fire clearance was approved for all six residents may be non-ambulatory. LPAs toured facility with Administrator and Care Staff including but not limited to 6 residents bedrooms, 2 staff rooms, 4 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 71 degrees F and hot water temperature was maintained at 107.6 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 11/1/2021. During record review, LPAs reviewed a sample of 2 residents and 3 staff records. 2 of 2 residents and 3 of 3 staff have current records maintained. The following were cited and corrected from a Case Management for existing license (#075601511 ): At 10:30 AM, LPAs observed two knives being stored inside dishwasher accessible to residents. Deficiency cleared during visit. Staff removed both knives and locked it away. At 10:33 AM, LPAs observed laundry detergent unlocked placed above laundry machines. Deficiency cleared during visit. Staff removed detergents from shelf and locked it away inside a cabinet. REPORT CONTINUES ON 809C 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 LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.

On 5/6/2022 starting at 12:30 PM, Licensing Program Analysts (LPAs) L. Francisco and K. Nguyen conducted a face to face Component III presentation. LPAs conducted Component III with Administrator, Fathma Ansari. LPAs presented Component III power point and discussed the regulations embodied in the power point. LPAs observed participant gained knowledge about running and maintaining the facility in accordance with regulations. Exit interview conducted and a copy of report provided.

On 04/21/2022 applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting Pre-licensing readiness