<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320019
Report Date: 05/11/2021
Date Signed: 05/18/2021 04:34:27 PM

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
02/01/2021 and conducted by Evaluator Don Senaha
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210201164434
FACILITY NAME:A GRAND HOME CAREFACILITY NUMBER:
198320019
ADMINISTRATOR:DE GUZMAN, HEPZHIBAHFACILITY TYPE:
740
ADDRESS:1132 LEVINSON STTELEPHONE:
(424) 271-7095
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY:6CENSUS: 5DATE:
05/11/2021
UNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Ethel CulalaTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not serving food of the quality or quantity to meet the residents' needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/11/2021 Licensing Program Analyst (LPA) Don Senaha and Licensing Program Manager (LPM) Eva Alvarez conducted a subsequent visit to deliver complaint findings. LPA met with Administrator Ethel Culala and explained the purpose of the visit.

On 02/05/2021 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation 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 via facetime with Administrator Ethel Culala.

The investigation consisted of the following: telephone/video interviews conducted with the staff (S1-S4) and residents (R1-R6). Residents (R2, R4) declined to be interviewed. LPA obtained copies of a current staff roster, resident roster, menu and house rules. LPA conducted a plant inspection virtually with Administrator/ Ethel Culala.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021
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 2
Control Number 11-AS-20210201164434
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: A GRAND HOME CARE
FACILITY NUMBER: 198320019
VISIT DATE: 05/11/2021
NARRATIVE
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
Allegation: Facility is not serving food of the quality or quantity to meet the residents’ needs.

LPA conducted interviews with residents (R1, R3, R5-R6) and staff (S1-S4). Residents (R1, R3, R5-R6) stated the food tastes good. Residents (R1, R3, R5-R6) stated there is enough food, including snacks served. Resident (R5) stated she gets way too much food. Residents had no issues with the food service requirements. Staff (S1-S4) stated the residents are served breakfast, lunch and dinner with snacks. Staff (S1-S4) confirmed a resident can ask for more food. LPA observed during inspection an adequate food supplies of non-perishable for a minimum of one week and perishable food for a minimum of two days on the premises. LPA obtained and reviewed a four-week menu cycle with a variety of foods to meet the quality and quantity necessary to meet the needs of the residents.

Based on LPA’s observation, interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not enough preponderance of evidence to prove the alleged allegations are valid did or did not occur, therefore the allegations are "Unsubstantiated".

An exit interview was conducted with Ethel Culala, and a hard copy was provided for signature.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2