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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607206
Report Date: 02/04/2022
Date Signed: 07/05/2022 10:55:50 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2021 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20210113083145
FACILITY NAME:GOLDEN CARE LIVING, INC.FACILITY NUMBER:
197607206
ADMINISTRATOR:ANGELIQUE S. GRADNEYFACILITY TYPE:
740
ADDRESS:2052 REDONDELA DRIVETELEPHONE:
(310) 989-1941
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY:6CENSUS: 5DATE:
02/04/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:ADMINISTRATOR ANGELIQUE GRADNEYTIME COMPLETED:
10:06 AM
ALLEGATION(S):
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Staff failed to seek timely medical attention for resident.
Resident's toileting needs are not being met.
Resident's hygiene needs are not being met.'
Facility staff left resident in soiled bedding
Facility staff left resident in a soiled diaper.
Facility staff do not keep accurate records about resident in care.
INVESTIGATION FINDINGS:
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On 02/04/2022 around 01:00pm Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019(COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically via face time with Administrator Angelique Gradney.

The Investigation consisted of the following: On 01/19/2021 LPA Calderon interviewed Administrator Angelique Gradney (S1) and conducted a tour of the physical plant. On 2/01/2021 LPA obtained copies of Staff and Resident rosters, Resident #1’s record (Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months), medical records, Physicians Report and Medication list), ER medical reports Fire report. On 1/29/2021 LPA Calderon interviewed reporting party. On 2/01/2021 LPA Calderon interviewed S2-S5 and on 03/19/2021 LPA Calderon interviewed R1–R3. On 05/06/2021 LPA Calderon interviewed S2 regarding night crew. On 07/05/2022 LPA Calderon interviewed S1 for second time.

The investigation revealed the following:

Allegation: Staff failed to seek timely medical attention for resident.
It is alleged on Staff failed to seek timely medical attention for resident. On 01/12/2021 witness 1 stated that 911 was called and his unit of the Los Angeles Fire Department arrived around 8 am and entered the facility. W1 Fire captain noted that R1 urine and catheter had dislocated and therefore 911 was called. W1 states that he does not think this is elder abuse as R1 had just soiled himself and the night staff did not know how to change the catheter for R1. On 01/19/2021 LPA Calderon interviewed administrator S1 who stated her night staff did not have a chance to clean the resident or change R1 catheter and additional training was needed. On 03/19/2021 LPA Calderon interviewed R1-R3 could not answer questions due to dementia. On 02/01/2021 LPA Calderon interviewed S2-S5 who all stated that they also work the night shift and always take care of all resident’s medical needs. On 05/06/2021 LPA Calderon interviewed S2 who stated he worked the night shift and that R1 catheter dislodged around 5pm and he believes R1 had issues some time between the day and night shift. S2 stated additional training was done with all staff regarding catheter issues. On 02/01/2021 LPA Calderon reviewed Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months, medical records, Physicians Report and Medication list, ER medical reports an1d Fire report. The reports state that staff does take care of resident’s medical needs and keeps records for review.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
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 4
Control Number 11-AS-20210113083145
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GOLDEN CARE LIVING, INC.
FACILITY NUMBER: 197607206
VISIT DATE: 02/04/2022
NARRATIVE
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Allegation: Resident's toileting needs are not being met.
It is alleged on Resident's toileting needs are not being met. On 01/29/2021 Witness 1 stated that W` entered the facility and noted R1 had a soiled diaper and the bed was soiled. W1 states that W1 does not think this is elder abuse as R1 had just soiled himself and the night crew had not had a chance to clean R1 and R1 bed. On 01/19/2021 LPA Calderon interviewed administrator S1 who state S1 night staff did not have a chance to clean the resident or R1 bed and that W1 received paperwork stating the resident had been cleaned and R1 bed was changed. On 03/19/2021 LPA Calderon interviewed R1-R3 who stated that staff does take care of their hygiene needs and cleans their room daily. On 02/01/2021 LPA Calderon interviewed S2-S5 who all stated that they always take care of all residents needs to include soiled bedding, hygiene needs, medical attention, and keep records of what they do for residents every day. On 02/01/2021 LPA Calderon reviewed Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months, medical records, Physicians Report and Medication list, ER medical reports and Fire report. The reports state that staff does take care of residents needs and keeps records for review. On 04/28/2022 LPA Calderon interviewed administrator who stated that staff are not trained regarding Catheter replacement and that they call 911 or the hospice staff takes care of the resident’s needs. Administrator states that resident did not have a restrictive care plan as the hospice staff took care of resident’s medical needs or they called 911
Allegation: Resident's hygiene needs are not being met.
It is alleged on Resident's hygiene needs are not being met. On 01/29/2021 Witness 1 stated that W1 entered the facility and noted R1 had a soiled diaper and the bed was soiled. W1 states that he does not think this is elder abuse as R1 had just soiled R1 self and the night crew had not had a chance to clean R1 and R1 bed. On 01/19/2021 LPA Calderon interviewed administrator S1 who stated that S1 night staff did not have a chance to clean the resident or his bed prior to LAFD coming to the facility and that W1 received paperwork stating the resident had been cleaned and R1 bed was changed. On 03/19/2021 LPA Calderon interviewed R1-R3 who stated staff does take care of their hygiene needs and cleans their room daily. On 02/01/2021 LPA Calderon interviewed S2-S5 who all state that they always take care of all residents needs to include soiled bedding, hygiene needs, medical attention, and keep records of what they do for residents every day. On 02/01/2021 LPA Calderon reviewed Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months, medical records, Physicians Report and Medication list, ER medical reports and Fire report. The reports state that staff does take care of residents needs and keeps records for review. On 04/28/2022 LPA Calderon interviewed administrator who stated that staff are not trained regarding Catheter replacement and that they call 911 or the hospice staff takes care of the resident’s needs. Administrator states that resident did not have a restrictive care plan as the hospice staff took care of resident’s medical needs or they called 911
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 11-AS-20210113083145
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GOLDEN CARE LIVING, INC.
FACILITY NUMBER: 197607206
VISIT DATE: 02/04/2022
NARRATIVE
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Allegation: Facility staff left resident in soiled bedding.
It is alleged on Facility staff left resident in soiled bedding. On 01/29/2021 Witness 1 stated that W1 entered the facility and noted R1 had a soiled diaper and the bed was soiled. W1 states that W1 does not think this is elder abuse as R1 had just soiled R1 self and the night crew had not had a chance to clean R1 and R1 bed. On 01/19/2021 LPA Calderon interviewed administrator S1 who stated that S1 night staff did not have a chance to clean the resident or his bed prior to LAFD coming to the facility and that W1 received paperwork stating the resident had been cleaned and R1 bed was changed. On 03/19/2021 LPA Calderon interviewed R1-R3 who stated staff does take care of their hygiene needs and cleans their room daily. On 02/01/2021 LPA Calderon interviewed S2-S5 who all state that they always take care of all residents needs to include soiled bedding, hygiene needs, medical attention, and keep records of what they do for residents every day. On 02/01/2021 LPA Calderon reviewed Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months, medical records, Physicians Report and Medication list, ER medical reports and Fire report. The reports state that staff does take care of residents needs and keeps records for review. 04/28/2022 LPA Calderon interviewed administrator who stated that staff are not trained regarding Catheter replacement and that they call 911 or the hospice staff takes care of the resident’s needs. Administrator states that resident did not have a restrictive care plan as the hospice staff took care of resident’s medical needs or they called 911

Allegation: Facility staff left resident in a soiled diaper.
It is alleged on Facility staff left resident in a soiled diaper. On 01/29/2021 Witness 1 stated that W1 entered the facility and noted R1 had a soiled diaper and the bed was soiled. W1 states that W1 does not think this is elder abuse as R1 had just soiled R1 self and the night crew had not had a chance to clean R1 and R1 bed. On 01/19/2021 LPA Calderon interviewed administrator S1 who stated that S1 night staff did not have a chance to clean the resident or R1 bed prior to LAFD coming to the facility and that W1 received paperwork stating the resident had been cleaned and R1 bed was changed. On 03/19/2021 LPA Calderon interviewed R1-R3 who stated staff does take care of their hygiene needs and cleans their room daily. On 02/01/2021 LPA Calderon interviewed S2-S5 who all state that they always take care of all residents needs to include soiled bedding, hygiene needs, medical attention, and keep records of what they do for residents every day. On 02/01/2021 LPA Calderon reviewed Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months, medical records, Physicians Report and Medication list, ER medical reports and Fire report. The reports state that staff does take care of residents needs and keeps records for review.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20210113083145
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GOLDEN CARE LIVING, INC.
FACILITY NUMBER: 197607206
VISIT DATE: 02/04/2022
NARRATIVE
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Facility staff do not keep accurate records about resident in care:
On 01/29/2021 Witness 1 stated that he entered the facility and noted R1 had a soiled diaper and the bed was soiled. W1 states that W1 does not think this is elder abuse as R1 had just soiled R1 and the night crew had not had a chance to clean R1 and R1 bed. On 01/19/2021 LPA Calderon interviewed administrator S1 who stated that S1 night staff did not have a chance to clean the resident or R1 bed prior to LAFD coming to the facility and that W1 received paperwork stating the resident had been cleaned and R1 bed was changed. On 03/19/2021 LPA Calderon interviewed R1-R3 who stated staff does take care of their hygiene needs and cleans their room daily. On 02/01/2021 LPA Calderon interviewed S2-S5 who all state that they always take care of all residents needs to include soiled bedding, hygiene needs, medical attention, and keep records of what they do for residents every day. On 02/01/2021 LPA Calderon reviewed Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months, medical records, Physicians Report and Medication list, ER medical reports and Fire report. The reports state that staff does take care of residents needs and keeps records for review.


Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

A telephonic exit interview was conducted with Administrator Angelique Gradney, and a hard copy was provided via email for records
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4