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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607206
Report Date: 05/08/2025
Date Signed: 05/08/2025 03:33:07 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2025 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 11-AS-20250429140725
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:
05/08/2025
UNANNOUNCEDTIME BEGAN:
07:58 AM
MET WITH:Rodolfo LozadaTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Facility is in disrepair (exposed wiring).
Staff do not provide resident adequate personal accommodations.
INVESTIGATION FINDINGS:
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On 05/08/2025 at 8:00 a.m., Licensing Program Analyst (LPA) Antonine Richard conducted an initial complaint visit regarding the allegations above. LPA met with the Administrator (A1), Rodolfo Lozada, and the purpose of the visit was explained. LPA was granted entry to the facility.

The investigation consisted of the following: On 05/08/25, LPA reviewed and obtained the client roster (dated 04/21/25), staff roster (dated 04/21/25), Admission agreement (dated 04/03/24), and Face sheet of resident #1 (R1), Home Depot Receipt of purchased (dated 04/14/25), LPA reviewed the Plan Of Operation, LPA interviewed three residents #1-3 (R1-R3), three staff members #1- 3 (S1-S3), and the Administrator (A1). LPA and the administrator toured the facility inside and out.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
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 4
Control Number 11-AS-20250429140725
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GOLDEN CARE LIVING, INC.
FACILITY NUMBER: 197607206
VISIT DATE: 05/08/2025
NARRATIVE
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Allegation #1: The Facility is in disrepair (exposed wiring).

It has been alleged that there were exposed wires in the ceiling of one of the residents' rooms, where either a fan or an overhead light was connected. On May 8, 2025, between 8:30 AM and 9:00 AM, the Licensing Program Analyst (LPA) interviewed the administrator (A1) regarding the allegation facility is in disrepair due to exposed wiring in the facility. A1 explained that a resident had requested a replacement for the ceiling light bulb. On April 14, 2025, A1 went to Home Depot and purchased a ceiling light bulb, which resulted in the wiring being exposed temporarily; however, A1 assured that there were no safety issues and that the light bulb was replaced the same day.

On May 8, 2025, between 9:00 AM and 10:30 AM, the LPA interviewed three residents (R1, R2, and R3). All three denied the allegation, stating that they had no issues with the electrical wiring in their rooms. R1 and R2 mentioned that three weeks prior, they had asked the administrator to change the light bulb in the ceiling.

On May 8, 2025, between 10:30 AM and 11:30 AM, LPA Richard interviewed three staff members (S1, S2, and S3). All three staff members denied the allegation, stated that the facility is maintained in a clean, safe, sanitary condition and is in good repair at all times. Each staff member confirmed that there were no exposed wires in any resident rooms.

Report continued on LIC9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250429140725
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GOLDEN CARE LIVING, INC.
FACILITY NUMBER: 197607206
VISIT DATE: 05/08/2025
NARRATIVE
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On May 8, 2025, the Licensing Program Analyst (LPA) conducted a tour of each room and found that all rooms were clean and free of exposed wires in the ceilings. LPA also observed a brand-new ceiling light in the resident's room, which was equipped with three light bulbs. Additionally, the LPA received a copy of the Home Depot receipt dated April 14, 2025, for the purchase of a flush mount black ceiling light.

Based on interviews, observations, and a review of records, there was insufficient evidence to support the allegation. Although the allegation may have happened or is valid, there was not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is deemed unsubstantiated.

Allegation #2 stated that staff do not provide residents with adequate personal accommodations.

It is being alleged that a resident was using a small desk lamp to read, which the resident had purchased, and the resident's room appeared to be very dark. On May 8, 2025, between 8:30 AM and 9:30 AM, LPA interviewed A1 regarding the above allegation. A1 denied the allegation, stating that all the residents have a desk lamp in their room. We have some residents who don’t want to use it; they put the desk lamp in their closet, and they would rather use their own they purchased from the outside.

Report continued LIC9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250429140725
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GOLDEN CARE LIVING, INC.
FACILITY NUMBER: 197607206
VISIT DATE: 05/08/2025
NARRATIVE
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On May 8, 2025, between 9:00 AM and 10:30 AM, (LPA) Richard interviewed three residents (R1, R2, and R3). All three residents denied the allegations and stated that they had no issues with the desk lamp they purchased. Residents R1 and R2 stated that the ceiling lamp was too bright for reading at night, and they preferred to use the small desk lamp for their reading.

On May 8, 2025, between 10:30 AM to 11:30 AM, LPA Richard interviewed three staff members #1-3 (S1, S2, and S3). All three staff members also denied the allegations and stated that residents were provided with desk lamps by the facility. During the visit, LPA observed that all residents' rooms contained the required furniture, including desk lamps. The rooms were well-lit and not dark.

Based on the interviews and observations, there was insufficient evidence to support the allegations. Although the allegation may have happened or is valid, there was not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is deemed unsubstantiated.

No deficiencies were cited, and an exit interview was conducted. A copy of the report was provided to staff member Rachel Lugtu.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4