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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607206
Report Date: 03/13/2023
Date Signed: 03/13/2023 01:39:18 PM

Document Has Been Signed on 03/13/2023 01:39 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
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: 4DATE:
03/13/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Rachel Lugtu TIME COMPLETED:
12:32 PM
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On 03/13/23, Licensing Program Analyst (LPA) Ernand Dabuet initiated a case management visit to the above facility to clear POCs. Today’s case management visit was conducted with Rachel Lugtu care staff and spoke with Administrator Catherine Espino via telephone, and today's visit was explained.

LPA and toured the entire facility to inspect if corrections were made for citations cited on 02/11/23 for complaint # 11-AS-20201222113312. Proof of corrections were sent via facsimile 02/12/23 and 02/16/23:

The administrator dd clear the following citations:
  • Administrators Qualifications and Duties - 87405 (a-C)
  • Personnel Requirements – General - 87411(a)
  • Allowable Health Conditions and the Use of Home Health Agencies - 87609 (c)
  • Prohibited Health Conditions - 87615 (a)(1)
  • Observation of the Resident - 87466

Citations that were all cleared did not incur civil penalties.

An exit interview was conducted with Rachel Lugtu, copy of the report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2023
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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